- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,890.45 / $7,943.28
| Facility | | $588.84 | $3,890.45 | $7,943.28 |
- 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
- $912.01 / $1,096.48 / $2,454.71
| Facility | | $912.01 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $398.11 / $2,454.71
| Facility | | $239.88 | $398.11 | $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 |