- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.88 / $4,518.60 / $13,841.56
| Facility | | $760.88 | $4,518.60 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,921.80 / $10,419.34 / $20,154.36
| Facility | | $7,921.80 | $10,419.34 | $20,154.36 |
- 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
- $760.88 / $1,369.58 / $5,405.32
| Facility | | $760.88 | $1,369.58 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.09 / $2,046.56 / $3,000.40
| Facility | | $972.09 | $2,046.56 | $3,000.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,529.66 / $6,178.00 / $8,816.00
| Facility | | $2,529.66 | $6,178.00 | $8,816.00 |