- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.54 / $690.54 / $3,638.00
| Facility | | $690.54 | $690.54 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,231.65 / $9,837.79 / $20,505.30
| Facility | | $3,231.65 | $9,837.79 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.10 / $2,331.54 / $5,608.83
| Facility | | $1,644.10 | $2,331.54 | $5,608.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.53 / $2,131.58 / $4,416.39
| Facility | | $1,336.53 | $2,131.58 | $4,416.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.89 / $1,354.51 / $12,002.00
| Facility | | $832.89 | $1,354.51 | $12,002.00 |
- 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 |