- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $3,630.78 / $8,128.31
| Facility | | $346.74 | $3,630.78 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,235.94 / $3,467.37
| Facility | | $575.44 | $3,235.94 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,905.46
| Facility | | $912.01 | $912.01 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $295.12 / $2,454.71
| Facility | | $169.82 | $295.12 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,041.74 / $3,311.31
| Facility | | $831.76 | $2,041.74 | $3,311.31 |