- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.00 / $3,620.00 / $12,040.00
| Facility | | $921.00 | $3,620.00 | $12,040.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.40 / $4,138.47 / $7,726.91
| Facility | | $2,226.40 | $4,138.47 | $7,726.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.10 / $702.10 / $702.10
| Facility | | $702.10 | $702.10 | $702.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.65 / $2,001.65 / $2,001.65
| Facility | | $2,001.65 | $2,001.65 | $2,001.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,909.30 / $26,542.00 / $26,542.00
| Facility | | $7,909.30 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.06 / $1,035.57 / $2,007.63
| Facility | | $774.06 | $1,035.57 | $2,007.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.06 / $1,048.08 / $2,096.34
| Facility | | $774.06 | $1,048.08 | $2,096.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |