- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.33 / $897.33 / $6,575.00
| Facility | | $897.33 | $897.33 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,947.86 / $24,828.68 / $56,091.46
| Facility | | $3,947.86 | $24,828.68 | $56,091.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,087.73 / $2,962.20 / $7,125.97
| Facility | | $2,087.73 | $2,962.20 | $7,125.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.06 / $2,708.16 / $5,611.00
| Facility | | $1,698.06 | $2,708.16 | $5,611.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.78 / $1,586.94 / $9,793.00
| Facility | | $965.78 | $1,586.94 | $9,793.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |