- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.36 / $4,241.22 / $13,841.56
| Facility | | $619.36 | $4,241.22 | $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
- $619.36 / $1,114.84 / $4,803.10
| Facility | | $619.36 | $1,114.84 | $4,803.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.05 / $1,523.12 / $2,961.89
| Facility | | $709.05 | $1,523.12 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |