- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.71 / $4,182.08 / $12,765.09
| Facility | | $848.71 | $4,182.08 | $12,765.09 |
- 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
- $624.61 / $1,175.15 / $4,038.98
| Facility | | $624.61 | $1,175.15 | $4,038.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $1,625.32 / $2,961.89
| Facility | | $953.00 | $1,625.32 | $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 |