- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.62 / $6,046.24 / $11,971.28
| Facility | | $549.62 | $6,046.24 | $11,971.28 |
- 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
- $748.70 / $748.70 / $7,771.35
| Facility | | $748.70 | $748.70 | $7,771.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.62 / $660.00 / $1,050.25
| Facility | | $549.62 | $660.00 | $1,050.25 |
- 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
- $2,102.60 / $25,682.95 / $26,542.00
| Facility | | $2,102.60 | $25,682.95 | $26,542.00 |