- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.68 / $794.71 / $12,247.00
| Facility | | $393.68 | $794.71 | $12,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.89 / $1,794.89 / $1,821.08
| Facility | | $1,794.89 | $1,794.89 | $1,821.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.48 / $1,182.48 / $2,062.80
| Facility | | $1,182.48 | $1,182.48 | $2,062.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.68 / $663.00 / $1,009.80
| Facility | | $393.68 | $663.00 | $1,009.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.00 / $7,162.00 / $10,397.00
| Facility | | $1,711.00 | $7,162.00 | $10,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,327.30 / $2,327.30 / $26,542.00
| Facility | | $2,327.30 | $2,327.30 | $26,542.00 |