- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.33 / $837.33 / $6,781.00
| Facility | | $837.33 | $837.33 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,187.04 / $16,192.78 / $36,581.76
| Facility | | $4,187.04 | $16,192.78 | $36,581.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,219.37 / $3,147.34 / $7,571.34
| Facility | | $2,219.37 | $3,147.34 | $7,571.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.18 / $2,877.42 / $5,961.69
| Facility | | $1,804.18 | $2,877.42 | $5,961.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.76 / $1,830.85 / $12,002.00
| Facility | | $1,234.76 | $1,830.85 | $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 |