- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.73 / $910.73 / $11,423.14
| Facility | | $910.73 | $910.73 | $11,423.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,019.76 / $9,837.79 / $20,505.30
| Facility | | $4,019.76 | $9,837.79 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,235.37 / $3,170.03 / $7,625.94
| Facility | | $2,235.37 | $3,170.03 | $7,625.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,817.19 / $2,898.17 / $6,004.68
| Facility | | $1,817.19 | $2,898.17 | $6,004.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.96 / $1,723.00 / $12,002.00
| Facility | | $1,175.96 | $1,723.00 | $12,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,913.00 / $12,722.00 / $19,301.97
| Facility | | $5,913.00 | $12,722.00 | $19,301.97 |