- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,778.28 / $8,511.38
| Facility | | $457.09 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,801.89 / $8,511.38
| Facility | | $2,089.30 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $616.60
| Facility | | $380.19 | $467.74 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $2,290.87
| Facility | | $707.95 | $707.95 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,445.44 / $5,248.07
| Facility | | $524.81 | $1,445.44 | $5,248.07 |