- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.88 / $652.88 / $3,638.00
| Facility | | $652.88 | $652.88 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,859.03 / $9,232.28 / $20,505.30
| Facility | | $2,859.03 | $9,232.28 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,597.77 / $2,265.84 / $5,450.79
| Facility | | $1,597.77 | $2,265.84 | $5,450.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.88 / $2,071.52 / $4,291.96
| Facility | | $1,298.88 | $2,071.52 | $4,291.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.24 / $1,326.36 / $12,002.00
| Facility | | $842.24 | $1,326.36 | $12,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |