- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.61 / $941.62 / $8,229.00
| Facility | | $811.61 | $941.62 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,640.07 / $8,584.00 / $14,007.86
| Facility | | $4,640.07 | $8,584.00 | $14,007.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.14 / $1,198.43 / $1,382.48
| Facility | | $873.14 | $1,198.43 | $1,382.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.95 / $1,070.95 / $1,070.95
| Facility | | $1,070.95 | $1,070.95 | $1,070.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |