- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.35 / $944.35 / $7,285.00
| Facility | | $944.35 | $944.35 | $7,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,847.56 / $10,083.07 / $20,316.56
| Facility | | $3,847.56 | $10,083.07 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.55 / $2,971.75 / $7,148.96
| Facility | | $2,095.55 | $2,971.75 | $7,148.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.53 / $2,716.90 / $5,629.10
| Facility | | $1,703.53 | $2,716.90 | $5,629.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,328.53 / $1,927.27 / $12,367.00
| Facility | | $1,328.53 | $1,927.27 | $12,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |