- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.76 / $3,908.01 / $13,841.56
| Facility | | $696.76 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,949.61 / $3,879.54 / $7,504.28
| Facility | | $2,949.61 | $3,879.54 | $7,504.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.76 / $1,219.33 / $5,405.32
| Facility | | $696.76 | $1,219.33 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.68 / $1,727.97 / $2,961.89
| Facility | | $814.68 | $1,727.97 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |