- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.73 / $571.73 / $3,638.00
| Facility | | $571.73 | $571.73 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,859.02 / $10,944.24 / $23,673.40
| Facility | | $2,859.02 | $10,944.24 | $23,673.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.27 / $2,019.79 / $4,858.88
| Facility | | $1,424.27 | $2,019.79 | $4,858.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.83 / $1,846.57 / $3,825.89
| Facility | | $1,157.83 | $1,846.57 | $3,825.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.77 / $1,016.67 / $3,500.00
| Facility | | $643.77 | $1,016.67 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |