- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.25 / $531.25 / $6,781.00
| Facility | | $531.25 | $531.25 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,435.21 / $11,716.49 / $25,424.06
| Facility | | $2,435.21 | $11,716.49 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.47 / $1,823.90 / $4,387.64
| Facility | | $1,285.47 | $1,823.90 | $4,387.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.60 / $1,667.48 / $3,454.84
| Facility | | $1,168.60 | $1,667.48 | $3,454.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.25 / $903.76 / $3,312.00
| Facility | | $531.25 | $903.76 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |