- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.39 / $773.39 / $2,525.00
| Facility | | $773.39 | $773.39 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,495.70 / $9,984.76 / $20,811.61
| Facility | | $3,495.70 | $9,984.76 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,796.16 / $2,803.34 / $6,743.81
| Facility | | $1,796.16 | $2,803.34 | $6,743.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,556.53 / $2,558.23 / $5,310.09
| Facility | | $1,556.53 | $2,558.23 | $5,310.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.80 / $1,401.45 / $2,424.13
| Facility | | $788.80 | $1,401.45 | $2,424.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |