- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,570.40 / $6,456.54
| Facility | | $1,122.02 | $2,570.40 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,623.41 / $9,332.54
| Facility | | $3,090.30 | $5,623.41 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $10,964.78 / $10,964.78
| Facility | | $54.95 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,570.88 / $7,585.78
| Facility | | $2,754.23 | $4,570.88 | $7,585.78 |