- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,548.82 / $8,709.64
| Facility | | $933.25 | $1,548.82 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,456.54 / $10,232.93
| Facility | | $2,630.27 | $6,456.54 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $1,737.80
| Facility | | $707.95 | $891.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $6,025.60 / $10,471.29
| Facility | | $645.65 | $6,025.60 | $10,471.29 |