- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.31 / $979.31 / $7,397.00
| Facility | | $979.31 | $979.31 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.13 / $9,563.57 / $21,331.89
| Facility | | $5,091.13 | $9,563.57 | $21,331.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,281.36 / $3,560.61 / $8,565.53
| Facility | | $2,281.36 | $3,560.61 | $8,565.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,977.00 / $3,249.29 / $6,744.51
| Facility | | $1,977.00 | $3,249.29 | $6,744.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.78 / $1,749.40 / $3,110.05
| Facility | | $1,039.78 | $1,749.40 | $3,110.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |