- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.41 / $6,858.40 / $14,638.40
| Facility | | $865.41 | $6,858.40 | $14,638.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.36 / $691.51 / $1,039.30
| Facility | | $563.36 | $691.51 | $1,039.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,186.12 / $8,957.00 / $26,542.00
| Facility | | $2,186.12 | $8,957.00 | $26,542.00 |