- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.26 / $775.84 / $6,205.00
| Facility | | $570.26 | $775.84 | $6,205.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,725.36 / $12,197.67 / $25,424.06
| Facility | | $2,725.36 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,918.53 / $2,722.12 / $6,548.42
| Facility | | $1,918.53 | $2,722.12 | $6,548.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.12 / $2,488.67 / $5,156.24
| Facility | | $1,744.12 | $2,488.67 | $5,156.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.46 / $1,167.50 / $2,127.09
| Facility | | $623.46 | $1,167.50 | $2,127.09 |
- 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 |