- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.36 / $6,401.58 / $12,167.39
| Facility | | $984.36 | $6,401.58 | $12,167.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,221.47 / $3,221.47 / $4,603.08
| Facility | | $3,221.47 | $3,221.47 | $4,603.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,888.33
| Facility | | $606.10 | $606.10 | $7,888.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.57 / $883.44 / $1,313.59
| Facility | | $632.57 | $883.44 | $1,313.59 |
- 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
- $2,418.36 / $26,069.55 / $26,542.00
| Facility | | $2,418.36 | $26,069.55 | $26,542.00 |