- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.93 / $881.11 / $2,525.00
| Facility | | $665.93 | $881.11 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,080.70 / $12,197.67 / $25,424.06
| Facility | | $3,080.70 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,131.51 / $3,024.31 / $7,275.39
| Facility | | $2,131.51 | $3,024.31 | $7,275.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.74 / $2,764.94 / $5,728.65
| Facility | | $1,937.74 | $2,764.94 | $5,728.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.57 / $1,323.28 / $2,325.77
| Facility | | $672.57 | $1,323.28 | $2,325.77 |
- 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 |