- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.46 / $4,778.89 / $13,841.56
| Facility | | $638.46 | $4,778.89 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- 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
- $363.07 / $671.68 / $4,803.10
| Facility | | $363.07 | $671.68 | $4,803.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $953.00 / $2,961.89
| Facility | | $627.00 | $953.00 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |