- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.78 / $7,753.12 / $8,763.29
| Facility | | $668.78 | $7,753.12 | $8,763.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,703.05 / $8,392.32 / $13,362.65
| Facility | | $2,703.05 | $8,392.32 | $13,362.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.56 / $715.56 / $1,656.16
| Facility | | $715.56 | $715.56 | $1,656.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.74 / $522.03 / $812.42
| Facility | | $365.74 | $522.03 | $812.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $6,599.00 / $11,994.45
| Facility | | $936.00 | $6,599.00 | $11,994.45 |