- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,698.24 / $4,365.16
| Facility | | $891.25 | $1,698.24 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,370.32 / $7,762.47
| Facility | | $3,162.28 | $5,370.32 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $7,943.28 / $7,943.28
| Facility | | $707.95 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $1,318.26
| Facility | | $489.78 | $812.83 | $1,318.26 |
- 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 |