- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,630.27 / $7,943.28
| Facility | | $512.86 | $2,630.27 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,801.89 / $8,511.38
| Facility | | $2,344.23 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $588.84
| Facility | | $331.13 | $446.68 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $1,862.09
| Facility | | $616.60 | $616.60 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |