- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,630.27 / $6,760.83
| Facility | | $436.52 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,778.28 / $2,884.03
| Facility | | $1,148.15 | $1,778.28 | $2,884.03 |
- 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
- $234.42 / $549.54 / $5,495.41
| Facility | | $234.42 | $549.54 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $6,025.60
| Facility | | $891.25 | $3,235.94 | $6,025.60 |