- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.00 / $672.00 / $4,828.00
| Facility | | $672.00 | $672.00 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,100.26 / $12,197.67 / $25,424.06
| Facility | | $3,100.26 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.62 / $2,336.31 / $5,620.32
| Facility | | $1,646.62 | $2,336.31 | $5,620.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,496.93 / $2,135.94 / $4,425.45
| Facility | | $1,496.93 | $2,135.94 | $4,425.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.22 / $1,157.55 / $5,577.00
| Facility | | $731.22 | $1,157.55 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |