- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.60 / $4,043.00 / $10,170.00
| Facility | | $916.60 | $4,043.00 | $10,170.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,264.00 / $12,274.00
| Facility | | $4,100.00 | $7,264.00 | $12,274.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.61 / $1,141.61 / $10,957.50
| Facility | | $1,141.61 | $1,141.61 | $10,957.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.82 / $907.82 / $7,227.90
| Facility | | $907.82 | $907.82 | $7,227.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $853.28 / $2,091.65
| Facility | | $319.00 | $853.28 | $2,091.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $907.82 / $7,227.90
| Facility | | $555.00 | $907.82 | $7,227.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,031.00 / $4,840.00 / $9,202.00
| Facility | | $2,031.00 | $4,840.00 | $9,202.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.79 / $876.79 / $2,568.54
| Facility | | $876.79 | $876.79 | $2,568.54 |