- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.17 / $685.17 / $6,781.00
| Facility | | $685.17 | $685.17 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,201.39 / $8,480.52 / $17,676.25
| Facility | | $3,201.39 | $8,480.52 | $17,676.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,826.03 / $2,589.54 / $6,229.48
| Facility | | $1,826.03 | $2,589.54 | $6,229.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,484.43 / $2,367.46 / $4,905.10
| Facility | | $1,484.43 | $2,367.46 | $4,905.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.28 / $1,508.14 / $7,892.06
| Facility | | $952.28 | $1,508.14 | $7,892.06 |
- 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 |