- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,630.78 / $8,128.31
| Facility | | $489.78 | $3,630.78 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $977.24 / $1,258.93
| Facility | | $645.65 | $977.24 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $2,454.71
| Facility | | $1,096.48 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $331.13 / $2,454.71
| Facility | | $204.17 | $331.13 | $2,454.71 |
- 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 |