- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,778.28 / $8,511.38
| Facility | | $630.96 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,801.89 / $8,511.38
| Facility | | $2,344.23 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $851.14 / $1,071.52
| Facility | | $616.60 | $851.14 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,148.15 / $1,862.09
| Facility | | $933.25 | $1,148.15 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |