- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,398.83 / $6,456.54
| Facility | | $891.25 | $2,398.83 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,890.45 / $5,888.44
| Facility | | $1,584.89 | $3,890.45 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,041.74 / $4,265.80
| Facility | | $501.19 | $2,041.74 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $10,715.19
| Facility | | $54.95 | $56.23 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,548.13 / $6,025.60
| Facility | | $1,258.93 | $3,548.13 | $6,025.60 |