- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,630.27 / $6,760.83
| Facility | | $501.19 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,918.31 / $10,964.78
| Facility | | $4,365.16 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $660.69 / $5,495.41
| Facility | | $354.81 | $660.69 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $6,025.60
| Facility | | $891.25 | $3,235.94 | $6,025.60 |