- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.12 / $4,936.96 / $7,993.00
| Facility | | $591.12 | $4,936.96 | $7,993.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.15 / $1,627.07 / $2,761.08
| Facility | | $1,479.15 | $1,627.07 | $2,761.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $1,362.98 / $2,709.73
| Facility | | $515.00 | $1,362.98 | $2,709.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.47 / $528.57 / $855.07
| Facility | | $378.47 | $528.57 | $855.07 |
- 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
- $2,787.72 / $2,787.72 / $26,542.00
| Facility | | $2,787.72 | $2,787.72 | $26,542.00 |