- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.92 / $855.92 / $4,828.00
| Facility | | $855.92 | $855.92 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,537.82 / $10,188.53 / $20,811.61
| Facility | | $3,537.82 | $10,188.53 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.42 / $2,798.56 / $6,732.32
| Facility | | $1,973.42 | $2,798.56 | $6,732.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,604.25 / $2,558.56 / $5,301.04
| Facility | | $1,604.25 | $2,558.56 | $5,301.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.30 / $1,595.84 / $10,533.00
| Facility | | $1,082.30 | $1,595.84 | $10,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |