- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.56 / $441.56 / $3,091.00
| Facility | | $441.56 | $441.56 | $3,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.94 / $5,483.97 / $12,389.06
| Facility | | $883.94 | $5,483.97 | $12,389.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.95 / $1,598.15 / $3,844.58
| Facility | | $1,126.95 | $1,598.15 | $3,844.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.13 / $1,461.10 / $3,027.23
| Facility | | $916.13 | $1,461.10 | $3,027.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.24 / $934.50 / $7,770.00
| Facility | | $630.24 | $934.50 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |