- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.62 / $900.37 / $4,704.00
| Facility | | $702.62 | $900.37 | $4,704.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,194.80 / $12,197.67 / $25,424.06
| Facility | | $3,194.80 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,230.01 / $3,164.06 / $7,611.57
| Facility | | $2,230.01 | $3,164.06 | $7,611.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,027.28 / $2,892.71 / $5,993.36
| Facility | | $2,027.28 | $2,892.71 | $5,993.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.18 / $1,407.07 / $2,498.55
| Facility | | $747.18 | $1,407.07 | $2,498.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |