- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.45 / $1,434.14 / $10,048.70
| Facility | | $267.45 | $1,434.14 | $10,048.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $2,710.28
| Facility | | $395.75 | $395.75 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.45 / $393.75 / $1,101.00
| Facility | | $267.45 | $393.75 | $1,101.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.16 / $8,957.00 / $12,000.00
| Facility | | $1,013.16 | $8,957.00 | $12,000.00 |