- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.87 / $388.87 / $2,525.00
| Facility | | $388.87 | $388.87 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.94 / $9,212.18 / $20,811.61
| Facility | | $1,854.94 | $9,212.18 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.08 / $1,370.02 / $3,295.76
| Facility | | $966.08 | $1,370.02 | $3,295.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.35 / $1,252.52 / $2,595.09
| Facility | | $785.35 | $1,252.52 | $2,595.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.29 / $793.72 / $7,770.00
| Facility | | $535.29 | $793.72 | $7,770.00 |
- 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 |