- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.80 / $3,018.95 / $8,211.00
| Facility | | $678.80 | $3,018.95 | $8,211.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,494.80 / $1,644.27 / $2,790.28
| Facility | | $1,494.80 | $1,644.27 | $2,790.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.62 / $2,636.57 / $5,241.75
| Facility | | $486.62 | $2,636.57 | $5,241.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.94 / $687.05 / $1,009.01
| Facility | | $423.94 | $687.05 | $1,009.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,731.75 / $15,338.55 / $16,394.00
| Facility | | $2,731.75 | $15,338.55 | $16,394.00 |