- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.54 / $226.54 / $6,575.00
| Facility | | $226.54 | $226.54 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,103.64 / $8,758.52 / $17,287.45
| Facility | | $5,103.64 | $8,758.52 | $17,287.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.15 / $710.69 / $1,709.66
| Facility | | $501.15 | $710.69 | $1,709.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.40 / $649.74 / $1,346.19
| Facility | | $407.40 | $649.74 | $1,346.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.91 / $453.98 / $9,427.92
| Facility | | $338.91 | $453.98 | $9,427.92 |
- 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 |