- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.47 / $895.47 / $6,575.00
| Facility | | $895.47 | $895.47 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,097.27 / $12,446.60 / $25,424.06
| Facility | | $4,097.27 | $12,446.60 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,193.81 / $3,112.70 / $7,488.02
| Facility | | $2,193.81 | $3,112.70 | $7,488.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,994.37 / $2,845.75 / $5,896.08
| Facility | | $1,994.37 | $2,845.75 | $5,896.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.14 / $1,542.46 / $5,577.00
| Facility | | $881.14 | $1,542.46 | $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 |