- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,388.44 / $8,128.31
| Facility | | $794.33 | $3,388.44 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,090.30 / $4,897.79
| Facility | | $2,290.87 | $3,090.30 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $6,456.54
| Facility | | $478.63 | $794.33 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,630.78 / $5,623.41
| Facility | | $1,548.82 | $3,630.78 | $5,623.41 |