- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.60 / $234.42 / $1,202.26
| Facility | | $16.60 | $234.42 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $91.20 / $100.00
| Facility | | $67.61 | $91.20 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,413.10 / $16,595.87
| Facility | | $2,187.76 | $7,413.10 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,456.54 / $15,135.61
| Facility | | $1,778.28 | $6,456.54 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $194.98 / $316.23
| Facility | | $117.49 | $194.98 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,760.83 / $19,054.61
| Facility | | $1,659.59 | $6,760.83 | $19,054.61 |