- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,089.30 / $4,570.88
| Facility | | $891.25 | $2,089.30 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,011.87 / $7,943.28
| Facility | | $2,754.23 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $954.99
| Facility | | $39.81 | $39.81 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $8,912.51
| Facility | | $831.76 | $2,630.27 | $8,912.51 |