- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,951.21 / $7,413.10
| Facility | | $912.01 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $12,882.50 / $25,118.86
| Facility | | $5,888.44 | $12,882.50 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Facility | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $28,840.32 / $28,840.32
| Facility | | $26,915.35 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,412.54 / $4,365.16
| Facility | | $851.14 | $1,412.54 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,230.27 / $2,187.76
| Facility | | $891.25 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,918.31 / $14,454.40
| Facility | | $2,187.76 | $6,918.31 | $14,454.40 |