- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.83 / $284.83 / $2,525.00
| Facility | | $284.83 | $284.83 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.76 / $10,944.24 / $23,673.40
| Facility | | $1,365.76 | $10,944.24 | $23,673.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.35 / $1,009.30 / $2,428.00
| Facility | | $711.35 | $1,009.30 | $2,428.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.67 / $922.74 / $1,911.81
| Facility | | $646.67 | $922.74 | $1,911.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.16 / $516.61 / $5,577.00
| Facility | | $321.16 | $516.61 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |