- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.20 / $270.20 / $2,168.00
| Facility | | $270.20 | $270.20 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,465.39 / $14,249.16
| Facility | | $4,206.67 | $7,465.39 | $14,249.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.94 / $929.27 / $2,235.48
| Facility | | $654.94 | $929.27 | $2,235.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.40 / $849.58 / $1,760.23
| Facility | | $595.40 | $849.58 | $1,760.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.07 / $511.42 / $4,746.00
| Facility | | $294.07 | $511.42 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $7,770.00 / $10,734.22
| Facility | | $2,412.00 | $7,770.00 | $10,734.22 |