- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $7,943.28 / $14,791.08
| Facility | | $707.95 | $7,943.28 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,456.54 / $13,182.57
| Facility | | $2,951.21 | $6,456.54 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,137.96 / $2,754.23
| Facility | | $707.95 | $2,137.96 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $1,122.02
| Facility | | $446.68 | $676.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $13,182.57 / $23,442.29
| Facility | | $5,128.61 | $13,182.57 | $23,442.29 |