- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.82 / $5,781.82 / $16,139.10
| Facility | | $525.82 | $5,781.82 | $16,139.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.49 / $8,743.43 / $13,925.95
| Facility | | $3,863.49 | $8,743.43 | $13,925.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,957.27 / $8,957.27 / $11,510.25
| Facility | | $8,957.27 | $8,957.27 | $11,510.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.82 / $5,781.82 / $10,951.52
| Facility | | $525.82 | $5,781.82 | $10,951.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,902.53 / $17,146.00 / $24,161.00
| Facility | | $7,902.53 | $17,146.00 | $24,161.00 |