- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,162.28 / $7,943.28
| Facility | | $870.96 | $3,162.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,096.48 / $1,737.80
| Facility | | $831.76 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $812.83 / $5,623.41
| Facility | | $501.19 | $812.83 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,089.30 / $4,677.35
| Facility | | $1,445.44 | $2,089.30 | $4,677.35 |