- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.87 / $4,440.80 / $19,999.25
| Facility | | $661.87 | $4,440.80 | $19,999.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,011.56 / $9,425.79 / $17,519.04
| Facility | | $4,011.56 | $9,425.79 | $17,519.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.25 / $715.00 / $2,581.96
| Facility | | $663.25 | $715.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.90 / $673.05 / $1,259.78
| Facility | | $576.90 | $673.05 | $1,259.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |