- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.55 / $3,107.00 / $5,731.65
| Facility | | $715.55 | $3,107.00 | $5,731.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $9,039.00
| Facility | | $1,061.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.29 / $759.82 / $1,356.44
| Facility | | $591.29 | $759.82 | $1,356.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.02 / $1,078.16 / $7,315.92
| Facility | | $500.02 | $1,078.16 | $7,315.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.43 / $1,095.43 / $7,462.96
| Facility | | $1,095.43 | $1,095.43 | $7,462.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $26,542.00
| Facility | | $1,902.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |