- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,630.78 / $8,317.64
| Facility | | $407.38 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,238.72 / $2,344.23
| Facility | | $645.65 | $2,238.72 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,995.26 / $2,454.71
| Facility | | $1,288.25 | $1,995.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $346.74 / $1,445.44
| Facility | | $165.96 | $346.74 | $1,445.44 |
- 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 |