- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.50 / $3,920.00 / $12,941.00
| Facility | | $969.50 | $3,920.00 | $12,941.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.46 / $3,214.76 / $6,692.36
| Facility | | $1,799.46 | $3,214.76 | $6,692.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $664.69 / $723.55 / $723.55
| Facility | | $664.69 | $723.55 | $723.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,494.86 / $1,494.86 / $1,543.72
| Facility | | $1,494.86 | $1,494.86 | $1,543.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,887.55 / $26,542.00 / $26,542.00
| Facility | | $6,887.55 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.05 / $925.81 / $1,389.14
| Facility | | $735.05 | $925.81 | $1,389.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.52 / $934.27 / $1,513.26
| Facility | | $735.52 | $934.27 | $1,513.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.00 / $3,264.00 / $7,600.00
| Facility | | $1,120.00 | $3,264.00 | $7,600.00 |