- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,187.76 / $6,456.54
| Facility | | $501.19 | $2,187.76 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,311.31 / $5,248.07
| Facility | | $2,089.30 | $3,311.31 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $691.83 / $3,981.07
| Facility | | $204.17 | $691.83 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $3,801.89
| Facility | | $575.44 | $1,995.26 | $3,801.89 |