- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.06 / $6,673.80 / $12,725.50
| Facility | | $737.06 | $6,673.80 | $12,725.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.65 / $734.65 / $890.00
| Facility | | $734.65 | $734.65 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.06 / $921.33 / $1,440.50
| Facility | | $737.06 | $921.33 | $1,440.50 |
- 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 |