- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.55 / $2,181.00 / $7,316.00
| Facility | | $570.55 | $2,181.00 | $7,316.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.85 / $4,527.81 / $8,995.25
| Facility | | $2,386.85 | $4,527.81 | $8,995.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.43 / $446.43 / $446.43
| Facility | | $446.43 | $446.43 | $446.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.10 / $2,376.10 / $2,376.10
| Facility | | $2,376.10 | $2,376.10 | $2,376.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,388.90 / $12,000.00 / $12,000.00
| Facility | | $9,388.90 | $12,000.00 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.84 / $624.27 / $1,087.22
| Facility | | $484.84 | $624.27 | $1,087.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.84 / $627.26 / $1,256.26
| Facility | | $484.84 | $627.26 | $1,256.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,226.00 / $7,600.00
| Facility | | $1,154.00 | $3,226.00 | $7,600.00 |