- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $6,456.54
| Facility | | $162.18 | $162.18 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $19,498.45 / $45,708.82
| Facility | | $8,709.64 | $19,498.45 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $1,288.25
| Facility | | $380.19 | $537.03 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $1,023.29
| Facility | | $416.87 | $524.81 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $407.38 / $12,302.69
| Facility | | $251.19 | $407.38 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,000.00 / $20,892.96
| Facility | | $5,888.44 | $10,000.00 | $20,892.96 |