- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.08 / $713.08 / $6,101.00
| Facility | | $713.08 | $713.08 | $6,101.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,271.94 / $10,689.38 / $20,925.29
| Facility | | $6,271.94 | $10,689.38 | $20,925.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.41 / $2,707.78 / $6,513.94
| Facility | | $1,909.41 | $2,707.78 | $6,513.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.21 / $2,475.56 / $5,129.09
| Facility | | $1,552.21 | $2,475.56 | $5,129.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.21 / $1,589.30 / $10,533.00
| Facility | | $1,031.21 | $1,589.30 | $10,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |