- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $2,691.53 / $6,760.83
| Facility | | $316.23 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $2,754.23
| Facility | | $1,096.48 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $389.05 / $4,073.80
| Facility | | $165.96 | $389.05 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,041.74 / $4,073.80
| Facility | | $575.44 | $2,041.74 | $4,073.80 |