- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.07 / $361.07 / $4,828.00
| Facility | | $361.07 | $361.07 | $4,828.00 |
- 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
- $798.47 / $1,132.32 / $2,723.96
| Facility | | $798.47 | $1,132.32 | $2,723.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.10 / $1,035.22 / $2,144.85
| Facility | | $649.10 | $1,035.22 | $2,144.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.16 / $880.03 / $9,427.92
| Facility | | $567.16 | $880.03 | $9,427.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,991.00 / $9,404.00 / $12,039.98
| Facility | | $3,991.00 | $9,404.00 | $12,039.98 |