- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.12 / $771.12 / $6,781.00
| Facility | | $771.12 | $771.12 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.43 / $2,110.42 / $5,386.75
| Facility | | $816.43 | $2,110.42 | $5,386.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,719.06 / $2,437.84 / $5,864.56
| Facility | | $1,719.06 | $2,437.84 | $5,864.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,397.47 / $2,228.77 / $4,617.76
| Facility | | $1,397.47 | $2,228.77 | $4,617.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.58 / $1,330.72 / $10,831.00
| Facility | | $659.58 | $1,330.72 | $10,831.00 |
- 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 |