- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.37 / $832.37 / $6,781.00
| Facility | | $832.37 | $832.37 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.61 / $5,357.75 / $10,376.78
| Facility | | $3,028.61 | $5,357.75 | $10,376.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,938.73 / $2,750.78 / $6,617.38
| Facility | | $1,938.73 | $2,750.78 | $6,617.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.86 / $2,514.88 / $5,210.54
| Facility | | $1,576.86 | $2,514.88 | $5,210.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.39 / $1,472.06 / $4,013.00
| Facility | | $851.39 | $1,472.06 | $4,013.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,523.00 / $5,499.18 / $7,545.39
| Facility | | $2,523.00 | $5,499.18 | $7,545.39 |