- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.55 / $2,514.00 / $7,495.00
| Facility | | $285.55 | $2,514.00 | $7,495.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,560.03 / $2,781.33 / $5,438.66
| Facility | | $1,560.03 | $2,781.33 | $5,438.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.38 / $162.38 / $162.38
| Facility | | $162.38 | $162.38 | $162.38 |
- 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
- $903.88 / $16,394.00 / $16,394.00
| Facility | | $903.88 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.45 / $248.17 / $445.43
| Facility | | $179.45 | $248.17 | $445.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.45 / $253.41 / $500.89
| Facility | | $179.45 | $253.41 | $500.89 |
- 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 |