- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.79 / $208.79 / $2,525.00
| Facility | | $208.79 | $208.79 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $994.30 / $10,766.58 / $24,323.22
| Facility | | $994.30 | $10,766.58 | $24,323.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.83 / $690.38 / $1,660.81
| Facility | | $486.83 | $690.38 | $1,660.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.76 / $631.17 / $1,307.73
| Facility | | $395.76 | $631.17 | $1,307.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.82 / $403.47 / $9,404.00
| Facility | | $304.82 | $403.47 | $9,404.00 |
- 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 |