- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,570.40 / $5,888.44
| Facility | | $912.01 | $2,570.40 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,011.87 / $7,413.10
| Facility | | $2,344.23 | $5,011.87 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $2,238.72 / $2,238.72
| Facility | | $39.81 | $2,238.72 | $2,238.72 |
- 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
- $1,023.29 / $3,467.37 / $8,511.38
| Facility | | $1,023.29 | $3,467.37 | $8,511.38 |