- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.51 / $453.51 / $4,828.00
| Facility | | $453.51 | $453.51 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.85 / $5,677.23 / $12,389.06
| Facility | | $929.85 | $5,677.23 | $12,389.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,158.96 / $1,643.54 / $3,953.76
| Facility | | $1,158.96 | $1,643.54 | $3,953.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.15 / $1,502.59 / $3,113.20
| Facility | | $942.15 | $1,502.59 | $3,113.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.10 / $960.12 / $7,770.00
| Facility | | $631.10 | $960.12 | $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 |