- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,623.41 / $10,471.29
| Facility | | $977.24 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,073.80 / $4,073.80
| Facility | | $3,890.45 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $6,025.60
| Facility | | $467.74 | $741.31 | $6,025.60 |
- 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 |