- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.22 / $7,838.38 / $7,838.38
| Facility | | $599.22 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,339.06 / $8,392.32 / $13,362.65
| Facility | | $3,339.06 | $8,392.32 | $13,362.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.12 / $633.12 / $1,656.16
| Facility | | $633.12 | $633.12 | $1,656.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.49 / $615.04 / $931.60
| Facility | | $456.49 | $615.04 | $931.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.00 / $9,127.00 / $10,150.00
| Facility | | $1,230.00 | $9,127.00 | $10,150.00 |