- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,513.56 / $8,511.38
| Facility | | $338.84 | $1,513.56 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,398.83 / $4,365.16
| Facility | | $1,479.11 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $309.03 / $363.08
| Facility | | $218.78 | $309.03 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $1,659.59
| Facility | | $416.87 | $416.87 | $1,659.59 |
- 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 |