- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.07 / $3,766.00 / $10,874.00
| Facility | | $956.07 | $3,766.00 | $10,874.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,398.91 / $7,637.26 / $14,722.87
| Facility | | $4,398.91 | $7,637.26 | $14,722.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.12 / $636.12 / $636.12
| Facility | | $636.12 | $636.12 | $636.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,027.91 / $7,027.91 / $10,017.00
| Facility | | $7,027.91 | $7,027.91 | $10,017.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,736.47 / $12,650.00 / $27,770.10
| Facility | | $4,736.47 | $12,650.00 | $27,770.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.58 / $973.47 / $1,914.23
| Facility | | $694.58 | $973.47 | $1,914.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.58 / $990.75 / $1,930.25
| Facility | | $694.58 | $990.75 | $1,930.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,608.00 / $7,350.00 / $16,000.00
| Facility | | $2,608.00 | $7,350.00 | $16,000.00 |