- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.35 / $3,174.00 / $10,836.00
| Facility | | $574.35 | $3,174.00 | $10,836.00 |
- 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
- $296.04 / $313.47 / $313.47
| Facility | | $296.04 | $313.47 | $313.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.65 / $545.65 / $545.65
| Facility | | $545.65 | $545.65 | $545.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.44 / $11,500.00 / $26,542.00
| Facility | | $1,511.44 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.71 / $508.08 / $786.71
| Facility | | $329.71 | $508.08 | $786.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.71 / $513.66 / $817.41
| Facility | | $329.71 | $513.66 | $817.41 |
- 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 |