- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $2,511.89
| Facility | | $794.33 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $363.08 / $1,584.89
| Facility | | $28.18 | $363.08 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,023.29 / $1,202.26
| Facility | | $912.01 | $1,023.29 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,023.29 / $1,202.26
| Facility | | $912.01 | $1,023.29 | $1,202.26 |