- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.76 / $570.76 / $3,638.00
| Facility | | $570.76 | $570.76 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,511.39 / $8,041.59 / $16,510.18
| Facility | | $4,511.39 | $8,041.59 | $16,510.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.08 / $2,172.67 / $5,226.67
| Facility | | $1,532.08 | $2,172.67 | $5,226.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.47 / $1,986.35 / $4,115.49
| Facility | | $1,245.47 | $1,986.35 | $4,115.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.69 / $1,273.59 / $8,934.85
| Facility | | $816.69 | $1,273.59 | $8,934.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |