- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.11 / $5,611.88 / $10,910.57
| Facility | | $525.11 | $5,611.88 | $10,910.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.11 / $734.61 / $1,243.85
| Facility | | $525.11 | $734.61 | $1,243.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,526.25 / $8,957.00 / $33,500.00
| Facility | | $2,526.25 | $8,957.00 | $33,500.00 |