- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.71 / $611.71 / $3,119.00
| Facility | | $611.71 | $611.71 | $3,119.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,884.73 / $9,806.76 / $19,129.86
| Facility | | $3,884.73 | $9,806.76 | $19,129.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.35 / $2,208.51 / $5,312.87
| Facility | | $1,557.35 | $2,208.51 | $5,312.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.01 / $2,019.11 / $4,183.35
| Facility | | $1,266.01 | $2,019.11 | $4,183.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.93 / $1,295.46 / $12,002.00
| Facility | | $860.93 | $1,295.46 | $12,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |