- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.54 / $345.54 / $2,486.00
| Facility | | $345.54 | $345.54 | $2,486.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,124.92 / $10,523.44 / $37,568.37
| Facility | | $4,124.92 | $10,523.44 | $37,568.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.25 / $1,080.96 / $2,600.40
| Facility | | $762.25 | $1,080.96 | $2,600.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.65 / $988.26 / $2,047.56
| Facility | | $619.65 | $988.26 | $2,047.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.92 / $707.90 / $9,404.00
| Facility | | $542.92 | $707.90 | $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 |