- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.67 / $6,732.07 / $19,276.96
| Facility | | $604.67 | $6,732.07 | $19,276.96 |
- 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
- $544.21 / $874.95 / $2,353.96
| Facility | | $544.21 | $874.95 | $2,353.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,422.11 / $2,842.49
| Facility | | $1,089.00 | $1,422.11 | $2,842.49 |
- 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 |