- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.42 / $921.42 / $6,575.00
| Facility | | $921.42 | $921.42 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,605.15 / $6,772.19 / $14,294.22
| Facility | | $3,605.15 | $6,772.19 | $14,294.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,139.92 / $3,036.25 / $7,304.12
| Facility | | $2,139.92 | $3,036.25 | $7,304.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,740.51 / $2,775.86 / $5,751.28
| Facility | | $1,740.51 | $2,775.86 | $5,751.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.55 / $1,557.20 / $6,927.00
| Facility | | $903.55 | $1,557.20 | $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 |