- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.88 / $698.88 / $6,781.00
| Facility | | $698.88 | $698.88 | $6,781.00 |
- 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
- $1,700.50 / $2,412.76 / $5,804.22
| Facility | | $1,700.50 | $2,412.76 | $5,804.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.91 / $2,205.84 / $4,570.25
| Facility | | $1,545.91 | $2,205.84 | $4,570.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.40 / $1,200.40 / $4,273.00
| Facility | | $710.40 | $1,200.40 | $4,273.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |