- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,818.38 / $8,511.38
| Facility | | $707.95 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,715.19 / $11,220.18
| Facility | | $6,606.93 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $870.96 / $1,047.13
| Facility | | $616.60 | $870.96 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,071.52 / $1,174.90
| Facility | | $34.67 | $1,071.52 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,466.84 / $30,199.52
| Facility | | $602.56 | $4,466.84 | $30,199.52 |