- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,041.74 / $4,570.88
| Facility | | $758.58 | $2,041.74 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,025.60 / $10,964.78
| Facility | | $3,019.95 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $5,495.41 / $5,495.41
| Facility | | $537.03 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $4,265.80
| Facility | | $724.44 | $954.99 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $7,943.28
| Facility | | $831.76 | $2,630.27 | $7,943.28 |