- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.68 / $385.68 / $6,575.00
| Facility | | $385.68 | $385.68 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,193.12 / $16,101.53 / $31,408.96
| Facility | | $7,193.12 | $16,101.53 | $31,408.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.53 / $1,207.57 / $2,904.98
| Facility | | $851.53 | $1,207.57 | $2,904.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.23 / $1,104.01 / $2,287.39
| Facility | | $692.23 | $1,104.01 | $2,287.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.12 / $756.24 / $12,367.00
| Facility | | $549.12 | $756.24 | $12,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |