- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.13 / $714.13 / $3,638.00
| Facility | | $714.13 | $714.13 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,802.72 / $22,684.35 / $47,458.49
| Facility | | $7,802.72 | $22,684.35 | $47,458.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.08 / $2,574.01 / $6,192.12
| Facility | | $1,815.08 | $2,574.01 | $6,192.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,475.53 / $2,353.26 / $4,875.68
| Facility | | $1,475.53 | $2,353.26 | $4,875.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.24 / $1,509.45 / $12,586.00
| Facility | | $1,056.24 | $1,509.45 | $12,586.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,658.00 / $9,417.74 / $13,372.00
| Facility | | $5,658.00 | $9,417.74 | $13,372.00 |