- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,778.28 / $8,511.38
| Facility | | $512.86 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,801.89 / $8,511.38
| Facility | | $2,344.23 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $794.33
| Facility | | $478.63 | $676.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $912.01 / $1,862.09
| Facility | | $676.08 | $912.01 | $1,862.09 |
- 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 |