- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $3,467.37 / $8,128.31
| Facility | | $338.84 | $3,467.37 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,380.38
| Facility | | $645.65 | $870.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,096.48 / $2,454.71
| Facility | | $794.33 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $3,311.31
| Facility | | $162.18 | $257.04 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,445.44 / $3,311.31
| Facility | | $831.76 | $1,445.44 | $3,311.31 |