- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $8,511.38
| Facility | | $549.54 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,801.89 / $8,511.38
| Facility | | $2,290.87 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $489.78 / $588.84
| Facility | | $354.81 | $489.78 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,862.09
| Facility | | $478.63 | $660.69 | $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 |