- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,819.70 / $9,772.37
| Facility | | $407.38 | $1,819.70 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,412.54 / $2,630.27
| Facility | | $1,288.25 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,630.78 / $7,943.28
| Facility | | $691.83 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,630.78 / $7,943.28
| Facility | | $691.83 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $302.00 / $436.52
| Facility | | $263.03 | $302.00 | $436.52 |