- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,630.78 / $7,943.28
| Facility | | $933.25 | $3,630.78 | $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
- $602.56 / $602.56 / $1,778.28
| Facility | | $602.56 | $602.56 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $645.65 / $3,090.30
| Facility | | $398.11 | $645.65 | $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 |