- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.48 / $450.48 / $4,828.00
| Facility | | $450.48 | $450.48 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.27 / $5,677.23 / $12,389.06
| Facility | | $946.27 | $5,677.23 | $12,389.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.79 / $1,622.04 / $3,902.04
| Facility | | $1,143.79 | $1,622.04 | $3,902.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.82 / $1,482.94 / $3,072.48
| Facility | | $929.82 | $1,482.94 | $3,072.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.70 / $951.81 / $7,770.00
| Facility | | $702.70 | $951.81 | $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 |