- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.48 / $2,789.89 / $8,880.64
| Facility | | $636.48 | $2,789.89 | $8,880.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,787.52 / $2,787.52 / $2,828.19
| Facility | | $2,787.52 | $2,787.52 | $2,828.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $1,587.44
| Facility | | $748.70 | $748.70 | $1,587.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.72 / $883.01 / $1,352.94
| Facility | | $676.72 | $883.01 | $1,352.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,612.19 / $5,246.20 / $26,542.00
| Facility | | $2,612.19 | $5,246.20 | $26,542.00 |