- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,311.31 / $5,128.61
| Facility | | $2,089.30 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,818.38 / $19,054.61
| Facility | | $812.83 | $2,818.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $741.31
| Facility | | $50.12 | $676.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,090.30 / $8,511.38
| Facility | | $302.00 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,454.71 / $4,677.35
| Facility | | $295.12 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,818.38 / $19,054.61
| Facility | | $812.83 | $2,818.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,754.23 / $4,677.35
| Facility | | $794.33 | $2,754.23 | $4,677.35 |