- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.36 / $2,512.00 / $7,495.00
| Facility | | $518.36 | $2,512.00 | $7,495.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,535.57 / $4,708.92 / $9,025.43
| Facility | | $2,535.57 | $4,708.92 | $9,025.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.54 / $2,461.08 / $2,461.08
| Facility | | $145.54 | $2,461.08 | $2,461.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.10 / $2,376.10 / $2,376.10
| Facility | | $2,376.10 | $2,376.10 | $2,376.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.21 / $16,394.00 / $16,394.00
| Facility | | $809.21 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.67 / $414.08 / $1,005.08
| Facility | | $173.67 | $414.08 | $1,005.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.67 / $419.20 / $1,030.75
| Facility | | $173.67 | $419.20 | $1,030.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |