- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.50 / $5,445.72 / $10,087.00
| Facility | | $778.50 | $5,445.72 | $10,087.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,725.95 / $2,998.55 / $5,088.43
| Facility | | $2,725.95 | $2,998.55 | $5,088.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $2,997.51 / $5,654.79
| Facility | | $515.00 | $2,997.51 | $5,654.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.50 / $1,007.00 / $1,472.70
| Facility | | $778.50 | $1,007.00 | $1,472.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.00 / $2,050.00 / $15,712.00
| Facility | | $1,461.00 | $2,050.00 | $15,712.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,152.91 / $16,547.20
| Facility | | $55.00 | $5,152.91 | $16,547.20 |