- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.08 / $3,066.00 / $8,104.00
| Facility | | $657.08 | $3,066.00 | $8,104.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $26,582.19
| Facility | | $8,639.91 | $11,851.00 | $26,582.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.55 / $717.55 / $717.55
| Facility | | $717.55 | $717.55 | $717.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,439.84 / $4,439.84 / $4,439.84
| Facility | | $4,439.84 | $4,439.84 | $4,439.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.10 / $3,627.00 / $8,017.00
| Facility | | $716.10 | $3,627.00 | $8,017.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.55 / $717.55 / $717.55
| Facility | | $717.55 | $717.55 | $717.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.25 / $613.49 / $613.49
| Facility | | $547.25 | $613.49 | $613.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $4,563.00 / $9,631.00
| Facility | | $2,468.00 | $4,563.00 | $9,631.00 |