- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.73 / $318.73 / $4,828.00
| Facility | | $318.73 | $318.73 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.17 / $7,824.33 / $17,676.25
| Facility | | $1,481.17 | $7,824.33 | $17,676.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.32 / $1,201.59 / $2,890.62
| Facility | | $847.32 | $1,201.59 | $2,890.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.81 / $1,098.55 / $2,276.08
| Facility | | $688.81 | $1,098.55 | $2,276.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.87 / $650.33 / $10,533.00
| Facility | | $415.87 | $650.33 | $10,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |