- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,818.38 / $9,772.37
| Facility | | $758.58 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,073.80 / $9,549.93
| Facility | | $2,754.23 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $478.63
| Facility | | $295.12 | $407.38 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $2,290.87
| Facility | | $416.87 | $549.54 | $2,290.87 |
- 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 |