- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.86 / $669.86 / $6,575.00
| Facility | | $669.86 | $669.86 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.07 / $9,104.06 / $19,529.31
| Facility | | $2,904.07 | $9,104.06 | $19,529.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.23 / $2,103.40 / $5,060.01
| Facility | | $1,483.23 | $2,103.40 | $5,060.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,205.76 / $1,923.01 / $3,984.26
| Facility | | $1,205.76 | $1,923.01 | $3,984.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.17 / $1,371.50 / $12,367.00
| Facility | | $965.17 | $1,371.50 | $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 |