- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.38 / $7,791.00 / $8,426.25
| Facility | | $865.38 | $7,791.00 | $8,426.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,883.26 / $9,569.59 / $15,606.75
| Facility | | $3,883.26 | $9,569.59 | $15,606.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.68 / $422.68 / $1,023.75
| Facility | | $422.68 | $422.68 | $1,023.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.21 / $406.01 / $656.98
| Facility | | $349.21 | $406.01 | $656.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $3,085.00 / $5,060.00
| Facility | | $755.00 | $3,085.00 | $5,060.00 |