- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,388.44 / $8,128.31
| Facility | | $724.44 | $3,388.44 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $2,454.71
| Facility | | $1,148.15 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $707.95 / $5,623.41
| Facility | | $426.58 | $707.95 | $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 |