- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,778.28 / $8,511.38
| Facility | | $812.83 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,801.89 / $8,511.38
| Facility | | $2,290.87 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $1,548.82
| Facility | | $891.25 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $1,862.09
| Facility | | $1,096.48 | $1,659.59 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,890.45 / $8,511.38
| Facility | | $741.31 | $3,890.45 | $8,511.38 |