- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.58 / $610.58 / $4,828.00
| Facility | | $610.58 | $610.58 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.32 / $12,197.67 / $25,424.06
| Facility | | $3,038.32 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.88 / $2,115.34 / $5,088.75
| Facility | | $1,490.88 | $2,115.34 | $5,088.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.35 / $1,933.93 / $4,006.89
| Facility | | $1,355.35 | $1,933.93 | $4,006.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.69 / $1,065.32 / $3,293.00
| Facility | | $677.69 | $1,065.32 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $3,991.00 / $9,787.00
| Facility | | $2,740.00 | $3,991.00 | $9,787.00 |