- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.32 / $253.32 / $2,525.00
| Facility | | $253.32 | $253.32 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,505.60 / $6,498.38 / $12,890.36
| Facility | | $3,505.60 | $6,498.38 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.95 / $795.49 / $1,913.67
| Facility | | $560.95 | $795.49 | $1,913.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.01 / $727.27 / $1,506.83
| Facility | | $456.01 | $727.27 | $1,506.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.77 / $524.42 / $9,233.00
| Facility | | $360.77 | $524.42 | $9,233.00 |
- 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 |