- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $4,570.88 / $7,943.28
| Facility | | $707.95 | $4,570.88 | $7,943.28 |
- 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 / $1,778.28
| Facility | | $912.01 | $912.01 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $616.60 / $3,090.30
| Facility | | $398.11 | $616.60 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,187.76 / $4,677.35
| Facility | | $1,445.44 | $2,187.76 | $4,677.35 |