- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,630.78 / $7,943.28
| Facility | | $954.99 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $3,162.28
| Facility | | $1,479.11 | $2,089.30 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $707.95 / $3,630.78
| Facility | | $426.58 | $707.95 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,570.40 / $4,677.35
| Facility | | $1,548.82 | $2,570.40 | $4,677.35 |