- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.09 / $840.09 / $4,828.00
| Facility | | $840.09 | $840.09 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,993.07 / $11,589.55 / $23,673.40
| Facility | | $3,993.07 | $11,589.55 | $23,673.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,063.33 / $2,927.56 / $7,042.64
| Facility | | $2,063.33 | $2,927.56 | $7,042.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,875.75 / $2,676.49 / $5,545.39
| Facility | | $1,875.75 | $2,676.49 | $5,545.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $878.42 / $1,450.53 / $4,787.88
| Facility | | $878.42 | $1,450.53 | $4,787.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |