- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.42 / $907.48 / $8,413.00
| Facility | | $421.42 | $907.48 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.06 / $730.40 / $1,084.89
| Facility | | $434.06 | $730.40 | $1,084.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,956.48 / $2,128.00 / $26,542.00
| Facility | | $1,956.48 | $2,128.00 | $26,542.00 |