- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,513.56 / $8,511.38
| Facility | | $602.56 | $1,513.56 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,398.83 / $4,365.16
| Facility | | $1,513.56 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $954.99
| Facility | | $575.44 | $794.33 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $1,659.59
| Facility | | $812.83 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,890.45 / $8,511.38
| Facility | | $741.31 | $3,890.45 | $8,511.38 |