- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,778.28 / $8,511.38
| Facility | | $389.05 | $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
- $363.08 / $501.19 / $645.65
| Facility | | $363.08 | $501.19 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $691.83 / $1,862.09
| Facility | | $602.56 | $691.83 | $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 |