- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.71 / $5,103.76 / $16,091.58
| Facility | | $925.71 | $5,103.76 | $16,091.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,608.48 / $6,639.45 / $12,487.44
| Facility | | $2,608.48 | $6,639.45 | $12,487.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $2,144.17 / $2,755.30
| Facility | | $580.00 | $2,144.17 | $2,755.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.79 / $458.91 / $745.03
| Facility | | $343.79 | $458.91 | $745.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |