- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.52 / $7,838.38 / $7,838.38
| Facility | | $629.52 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,339.06 / $9,518.03 / $15,155.08
| Facility | | $3,339.06 | $9,518.03 | $15,155.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.44 / $676.44 / $1,996.40
| Facility | | $676.44 | $676.44 | $1,996.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.84 / $687.06 / $878.06
| Facility | | $539.84 | $687.06 | $878.06 |
- 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 |