- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,778.28 / $8,511.38
| Facility | | $363.08 | $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
- $338.84 / $467.74 / $562.34
| Facility | | $338.84 | $467.74 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $1,862.09
| Facility | | $467.74 | $630.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |