- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.64 / $707.64 / $6,575.00
| Facility | | $707.64 | $707.64 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,244.96 / $11,253.87 / $25,424.06
| Facility | | $3,244.96 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.75 / $2,448.59 / $5,890.42
| Facility | | $1,725.75 | $2,448.59 | $5,890.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,568.87 / $2,238.60 / $4,638.13
| Facility | | $1,568.87 | $2,238.60 | $4,638.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.29 / $1,205.86 / $6,840.20
| Facility | | $721.29 | $1,205.86 | $6,840.20 |
- 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 |