- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,691.53 / $4,365.16
| Facility | | $588.84 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,128.61 / $7,762.47
| Facility | | $2,398.83 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $363.08 / $363.08
| Facility | | $39.81 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $707.95 / $1,202.26
| Facility | | $489.78 | $707.95 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $6,165.95
| Facility | | $831.76 | $2,398.83 | $6,165.95 |