- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $4,786.30 / $10,471.29
| Facility | | $467.74 | $4,786.30 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,786.30 / $5,011.87
| Facility | | $1,047.13 | $4,786.30 | $5,011.87 |
- 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
- $288.40 / $588.84 / $8,317.64
| Facility | | $288.40 | $588.84 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $6,309.57
| Facility | | $1,862.09 | $4,265.80 | $6,309.57 |