- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,951.21 / $7,413.10
| Facility | | $707.95 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $147.91 / $630.96
| Facility | | $144.54 | $147.91 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,148.15 / $1,445.44
| Facility | | $275.42 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $28,840.32 / $28,840.32
| Facility | | $4,897.79 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $446.68 / $1,380.38
| Facility | | $165.96 | $446.68 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $354.81 / $1,000.00
| Facility | | $165.96 | $354.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,511.89 / $4,786.30
| Facility | | $724.44 | $2,511.89 | $4,786.30 |