- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.00 / $3,186.00 / $9,961.00
| Facility | | $748.00 | $3,186.00 | $9,961.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,189.96 / $4,232.37 / $8,173.76
| Facility | | $2,189.96 | $4,232.37 | $8,173.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.65 / $2,478.67 / $2,478.67
| Facility | | $346.65 | $2,478.67 | $2,478.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.74 / $417.74 / $417.74
| Facility | | $417.74 | $417.74 | $417.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.88 / $11,500.00 / $26,542.00
| Facility | | $1,374.88 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.23 / $418.50 / $649.57
| Facility | | $338.23 | $418.50 | $649.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.82 / $420.57 / $674.88
| Facility | | $338.82 | $420.57 | $674.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,326.00 / $7,600.00
| Facility | | $1,154.00 | $3,326.00 | $7,600.00 |