- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,158.42 / $5,701.54 / $13,220.30
| Facility | | $1,158.42 | $5,701.54 | $13,220.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.25 / $1,030.95 / $1,699.02
| Facility | | $822.25 | $1,030.95 | $1,699.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,936.60 / $8,957.00 / $26,542.00
| Facility | | $3,936.60 | $8,957.00 | $26,542.00 |