- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.50 / $313.50 / $4,828.00
| Facility | | $313.50 | $313.50 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,786.86 / $5,677.23 / $12,389.06
| Facility | | $1,786.86 | $5,677.23 | $12,389.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.10 / $1,127.55 / $2,712.47
| Facility | | $795.10 | $1,127.55 | $2,712.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.36 / $1,030.84 / $2,135.80
| Facility | | $646.36 | $1,030.84 | $2,135.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.38 / $660.89 / $7,770.00
| Facility | | $466.38 | $660.89 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |