- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,890.45 / $8,511.38
| Facility | | $933.25 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,905.46 / $1,949.84
| Facility | | $1,819.70 | $1,905.46 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $6,918.31
| Facility | | $549.54 | $870.96 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,818.38 / $6,309.57
| Facility | | $1,862.09 | $2,818.38 | $6,309.57 |