- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.00 / $2,630.00 / $7,495.00
| Facility | | $652.00 | $2,630.00 | $7,495.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,062.80 / $3,872.05 / $7,494.30
| Facility | | $2,062.80 | $3,872.05 | $7,494.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.61 / $152.61 / $152.61
| Facility | | $152.61 | $152.61 | $152.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.30 / $2,403.30 / $2,403.30
| Facility | | $2,403.30 | $2,403.30 | $2,403.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,496.40 / $16,394.00 / $16,394.00
| Facility | | $9,496.40 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.97 / $205.48 / $359.09
| Facility | | $164.97 | $205.48 | $359.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.97 / $209.44 / $405.88
| Facility | | $164.97 | $209.44 | $405.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,347.00 / $7,600.00
| Facility | | $1,154.00 | $3,347.00 | $7,600.00 |