- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,570.88 / $10,471.29
| Facility | | $891.25 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,412.54 / $1,412.54
| Facility | | $1,318.26 | $1,412.54 | $1,412.54 |
- 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
- $338.84 / $562.34 / $6,025.60
| Facility | | $338.84 | $562.34 | $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 |