- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.80 / $445.80 / $4,828.00
| Facility | | $445.80 | $445.80 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,507.17 / $13,558.82 / $26,448.94
| Facility | | $5,507.17 | $13,558.82 | $26,448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.90 / $1,556.35 / $3,744.01
| Facility | | $1,096.90 | $1,556.35 | $3,744.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.19 / $1,422.88 / $2,948.04
| Facility | | $997.19 | $1,422.88 | $2,948.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.21 / $775.39 / $3,293.00
| Facility | | $448.21 | $775.39 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |