- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.15 / $718.15 / $2,525.00
| Facility | | $718.15 | $718.15 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,603.93 / $21,428.46 / $48,409.91
| Facility | | $3,603.93 | $21,428.46 | $48,409.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.21 / $2,513.09 / $6,045.58
| Facility | | $1,771.21 | $2,513.09 | $6,045.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.19 / $2,297.57 / $4,760.30
| Facility | | $1,610.19 | $2,297.57 | $4,760.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.71 / $1,376.36 / $9,370.00
| Facility | | $771.71 | $1,376.36 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |