- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.76 / $579.76 / $4,828.00
| Facility | | $579.76 | $579.76 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,933.49 / $9,758.48 / $20,505.30
| Facility | | $2,933.49 | $9,758.48 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,362.23 / $2,126.09 / $5,114.60
| Facility | | $1,362.23 | $2,126.09 | $5,114.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.50 / $1,940.20 / $4,027.25
| Facility | | $1,180.50 | $1,940.20 | $4,027.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.87 / $1,073.56 / $1,955.17
| Facility | | $628.87 | $1,073.56 | $1,955.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |