- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.16 / $2,663.12 / $3,625.00
| Facility | | $437.16 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.16 / $2,854.00 / $9,039.00
| Facility | | $606.16 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.56 / $441.47 / $807.51
| Facility | | $343.56 | $441.47 | $807.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.89 / $626.46 / $6,679.00
| Facility | | $290.89 | $626.46 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.79 / $2,310.79 / $2,310.79
| Facility | | $2,310.79 | $2,310.79 | $2,310.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.27 / $3,764.00 / $16,394.00
| Facility | | $1,469.27 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,366.46 / $9,821.00
| Facility | | $1,902.00 | $4,366.46 | $9,821.00 |