- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,089.30 / $6,606.93
| Facility | | $588.84 | $2,089.30 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,187.76 / $3,548.13
| Facility | | $1,412.54 | $2,187.76 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $645.65 / $2,630.27
| Facility | | $346.74 | $645.65 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,318.26 / $2,691.53
| Facility | | $371.54 | $1,318.26 | $2,691.53 |