- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.25 / $3,682.00 / $13,004.00
| Facility | | $916.25 | $3,682.00 | $13,004.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,596.09 / $4,714.74 / $10,083.24
| Facility | | $2,596.09 | $4,714.74 | $10,083.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.86 / $554.86 / $554.86
| Facility | | $554.86 | $554.86 | $554.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,804.61 / $2,804.61 / $2,804.61
| Facility | | $2,804.61 | $2,804.61 | $2,804.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,066.65 / $16,026.00 / $16,026.00
| Facility | | $4,066.65 | $16,026.00 | $16,026.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.89 / $783.42 / $1,414.97
| Facility | | $609.89 | $783.42 | $1,414.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.89 / $787.20 / $1,617.52
| Facility | | $609.89 | $787.20 | $1,617.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |