- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,162.28 / $7,943.28
| Facility | | $870.96 | $3,162.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,698.24 / $5,495.41
| Facility | | $1,000.00 | $1,698.24 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $912.01 / $933.25
| Facility | | $79.43 | $912.01 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $8,128.31
| Facility | | $54.95 | $56.23 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $3,715.35
| Facility | | $912.01 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,258.93 / $2,137.96
| Facility | | $933.25 | $1,258.93 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,606.93 / $13,803.84
| Facility | | $2,187.76 | $6,606.93 | $13,803.84 |