- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.98 / $1,061.49 / $5,449.00
| Facility | | $678.98 | $1,061.49 | $5,449.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $1,438.74
| Facility | | $395.75 | $395.75 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.56 / $1,047.21 / $1,571.01
| Facility | | $692.56 | $1,047.21 | $1,571.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,173.96 / $3,471.49 / $12,000.00
| Facility | | $3,173.96 | $3,471.49 | $12,000.00 |