- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.22 / $250.22 / $2,525.00
| Facility | | $250.22 | $250.22 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.23 / $10,766.58 / $24,323.22
| Facility | | $1,175.23 | $10,766.58 | $24,323.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.16 / $824.16 / $1,982.63
| Facility | | $581.16 | $824.16 | $1,982.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.44 / $753.48 / $1,561.13
| Facility | | $472.44 | $753.48 | $1,561.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.42 / $482.40 / $9,255.00
| Facility | | $345.42 | $482.40 | $9,255.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |