- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,513.56 / $5,495.41
| Facility | | $537.03 | $1,513.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,398.83 / $4,365.16
| Facility | | $1,513.56 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $741.31
| Facility | | $501.19 | $616.60 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $1,659.59
| Facility | | $630.96 | $933.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,949.84 / $6,309.57
| Facility | | $602.56 | $1,949.84 | $6,309.57 |