- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.29 / $164.29 / $6,575.00
| Facility | | $164.29 | $164.29 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,193.12 / $16,101.53 / $31,408.96
| Facility | | $7,193.12 | $16,101.53 | $31,408.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.02 / $514.79 / $1,238.42
| Facility | | $363.02 | $514.79 | $1,238.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.11 / $470.65 / $975.14
| Facility | | $295.11 | $470.65 | $975.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.43 / $335.78 / $12,367.00
| Facility | | $254.43 | $335.78 | $12,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |