- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.47 / $5,526.84 / $11,851.18
| Facility | | $743.47 | $5,526.84 | $11,851.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,665.09 / $3,665.09 / $3,718.57
| Facility | | $3,665.09 | $3,665.09 | $3,718.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $7,600.82
| Facility | | $530.04 | $530.04 | $7,600.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.47 / $1,060.65 / $1,558.34
| Facility | | $743.47 | $1,060.65 | $1,558.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,482.35 / $21,925.05 / $25,119.35
| Facility | | $3,482.35 | $21,925.05 | $25,119.35 |