- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.07 / $5,515.65 / $18,596.96
| Facility | | $698.07 | $5,515.65 | $18,596.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,891.80 / $7,123.05 / $12,504.35
| Facility | | $2,891.80 | $7,123.05 | $12,504.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $1,017.85 / $2,581.96
| Facility | | $890.00 | $1,017.85 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.07 / $1,206.86 / $1,815.22
| Facility | | $698.07 | $1,206.86 | $1,815.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,388.09 / $12,269.00 / $19,591.00
| Facility | | $2,388.09 | $12,269.00 | $19,591.00 |