- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,884.03 / $12,589.25
| Facility | | $616.60 | $2,884.03 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $17,782.79 / $17,782.79
| Facility | | $17,782.79 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,511.89 / $4,677.35
| Facility | | $954.99 | $2,511.89 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $1,995.26 / $5,128.61
| Facility | | $75.86 | $1,995.26 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $21,379.62 / $25,118.86
| Facility | | $17,782.79 | $21,379.62 | $25,118.86 |