- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.82 / $781.82 / $4,828.00
| Facility | | $781.82 | $781.82 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,686.90 / $12,264.75 / $25,424.06
| Facility | | $3,686.90 | $12,264.75 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,910.11 / $2,710.17 / $6,519.69
| Facility | | $1,910.11 | $2,710.17 | $6,519.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,736.47 / $2,477.75 / $5,133.60
| Facility | | $1,736.47 | $2,477.75 | $5,133.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.88 / $1,354.03 / $5,577.00
| Facility | | $857.88 | $1,354.03 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $11,890.00 / $23,633.78
| Facility | | $5,457.00 | $11,890.00 | $23,633.78 |