- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,801.89 / $8,128.31
| Facility | | $851.14 | $3,801.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,890.45 / $4,265.80
| Facility | | $3,019.95 | $3,890.45 | $4,265.80 |
- 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
- $537.03 / $912.01 / $9,549.93
| Facility | | $537.03 | $912.01 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,754.40 / $11,748.98
| Facility | | $2,818.38 | $5,754.40 | $11,748.98 |