- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.24 / $407.58 / $8,409.15
| Facility | | $197.24 | $407.58 | $8,409.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,978.00 / $6,373.77 / $11,110.48
| Facility | | $2,978.00 | $6,373.77 | $11,110.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.83 / $1,515.74 / $3,646.31
| Facility | | $1,068.83 | $1,515.74 | $3,646.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.88 / $1,385.75 / $2,871.11
| Facility | | $868.88 | $1,385.75 | $2,871.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.47 / $715.54 / $5,194.53
| Facility | | $367.47 | $715.54 | $5,194.53 |
- 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 |