- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.36 / $864.36 / $6,575.00
| Facility | | $864.36 | $864.36 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,078.03 / $10,038.57 / $20,505.30
| Facility | | $4,078.03 | $10,038.57 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,055.96 / $2,915.62 / $7,013.91
| Facility | | $2,055.96 | $2,915.62 | $7,013.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.35 / $2,665.57 / $5,522.76
| Facility | | $1,671.35 | $2,665.57 | $5,522.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.98 / $1,712.13 / $12,367.00
| Facility | | $1,059.98 | $1,712.13 | $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 |