- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.02 / $4,340.70 / $11,674.65
| Facility | | $382.02 | $4,340.70 | $11,674.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,476.67 / $4,962.14 / $8,777.32
| Facility | | $2,476.67 | $4,962.14 | $8,777.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $580.00 / $1,965.14
| Facility | | $580.00 | $580.00 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.00 / $300.50 / $471.00
| Facility | | $178.00 | $300.50 | $471.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |