- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.45 / $827.45 / $3,638.00
| Facility | | $827.45 | $827.45 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,906.51 / $11,258.94 / $23,174.60
| Facility | | $3,906.51 | $11,258.94 | $23,174.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.74 / $2,796.17 / $6,726.57
| Facility | | $1,971.74 | $2,796.17 | $6,726.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,602.88 / $2,556.37 / $5,296.51
| Facility | | $1,602.88 | $2,556.37 | $5,296.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.19 / $1,636.30 / $8,313.00
| Facility | | $1,044.19 | $1,636.30 | $8,313.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |