- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.04 / $811.04 / $6,781.00
| Facility | | $811.04 | $811.04 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,835.06 / $8,480.52 / $18,388.81
| Facility | | $3,835.06 | $8,480.52 | $18,388.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,149.46 / $3,048.20 / $7,332.85
| Facility | | $2,149.46 | $3,048.20 | $7,332.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.35 / $2,786.78 / $5,773.90
| Facility | | $1,747.35 | $2,786.78 | $5,773.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.56 / $1,531.60 / $4,746.00
| Facility | | $1,152.56 | $1,531.60 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |