- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,570.88 / $8,511.38
| Facility | | $912.01 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,698.24
| Facility | | $758.58 | $1,023.29 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,248.07 / $8,912.51
| Facility | | $912.01 | $5,248.07 | $8,912.51 |