- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.75 / $1,764.31 / $3,625.00
| Facility | | $729.75 | $1,764.31 | $3,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $2,552.32 / $8,498.00
| Facility | | $941.10 | $2,552.32 | $8,498.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.85 / $770.81 / $1,376.06
| Facility | | $599.85 | $770.81 | $1,376.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.11 / $1,093.76 / $6,679.00
| Facility | | $505.11 | $1,093.76 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,805.01 / $3,805.01 / $3,805.01
| Facility | | $3,805.01 | $3,805.01 | $3,805.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |