- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.37 / $925.37 / $5,293.00
| Facility | | $925.37 | $925.37 | $5,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,425.61 / $6,726.72 / $14,294.22
| Facility | | $3,425.61 | $6,726.72 | $14,294.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,138.25 / $3,033.86 / $7,298.37
| Facility | | $2,138.25 | $3,033.86 | $7,298.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,739.14 / $2,773.68 / $5,746.75
| Facility | | $1,739.14 | $2,773.68 | $5,746.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.15 / $1,563.88 / $6,927.00
| Facility | | $876.15 | $1,563.88 | $6,927.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |