- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.09 / $827.09 / $4,828.00
| Facility | | $827.09 | $827.09 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,275.20 / $10,038.57 / $20,505.30
| Facility | | $4,275.20 | $10,038.57 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,930.09 / $3,012.37 / $7,246.65
| Facility | | $1,930.09 | $3,012.37 | $7,246.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.59 / $2,748.98 / $5,706.03
| Facility | | $1,672.59 | $2,748.98 | $5,706.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $892.33 / $1,644.72 / $5,913.00
| Facility | | $892.33 | $1,644.72 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.00 / $9,370.00 / $12,774.00
| Facility | | $3,437.00 | $9,370.00 | $12,774.00 |