- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.64 / $2,514.00 / $7,495.00
| Facility | | $580.64 | $2,514.00 | $7,495.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,133.09 / $4,033.71 / $7,696.71
| Facility | | $2,133.09 | $4,033.71 | $7,696.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.01 / $358.01 / $547.54
| Facility | | $358.01 | $358.01 | $547.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,802.48 / $16,394.00 / $16,394.00
| Facility | | $2,802.48 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.13 / $550.49 / $808.33
| Facility | | $396.13 | $550.49 | $808.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.49 / $552.02 / $817.07
| Facility | | $395.49 | $552.02 | $817.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.00 / $3,314.00 / $7,600.00
| Facility | | $1,124.00 | $3,314.00 | $7,600.00 |