- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $2,238.72
| Facility | | $302.00 | $302.00 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $23,988.33 / $56,234.13
| Facility | | $1,995.26 | $23,988.33 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $2,691.53
| Facility | | $812.83 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,096.48 / $2,137.96
| Facility | | $870.96 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $588.84 / $12,022.64
| Facility | | $302.00 | $588.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $11,481.54 / $28,183.83
| Facility | | $4,786.30 | $11,481.54 | $28,183.83 |