- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.57 / $2,145.78 / $7,838.38
| Facility | | $612.57 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.61 / $8,392.32 / $13,362.65
| Facility | | $2,423.61 | $8,392.32 | $13,362.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.84 / $719.84 / $1,656.16
| Facility | | $719.84 | $719.84 | $1,656.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.99 / $492.58 / $719.84
| Facility | | $311.99 | $492.58 | $719.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $6,599.00 / $7,158.00
| Facility | | $936.00 | $6,599.00 | $7,158.00 |