- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,897.79 / $14,125.38
| Facility | | $891.25 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,317.64 / $10,964.78
| Facility | | $3,981.07 | $8,317.64 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $724.44 / $1,288.25
| Facility | | $562.34 | $724.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $10,715.19
| Facility | | $1,862.09 | $5,623.41 | $10,715.19 |