- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.83 / $883.38 / $8,413.00
| Facility | | $475.83 | $883.38 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,683.83
| Facility | | $606.10 | $606.10 | $1,683.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.83 / $740.47 / $1,108.80
| Facility | | $475.83 | $740.47 | $1,108.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,861.05 / $2,861.05 / $26,542.00
| Facility | | $2,861.05 | $2,861.05 | $26,542.00 |