- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,818.38 / $9,120.11
| Facility | | $794.33 | $2,818.38 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,073.80 / $9,549.93
| Facility | | $2,570.40 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $977.24 / $1,258.93
| Facility | | $707.95 | $977.24 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,318.26 / $2,290.87
| Facility | | $891.25 | $1,318.26 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,890.45 / $8,511.38
| Facility | | $741.31 | $3,890.45 | $8,511.38 |