- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $3,162.28 / $7,585.78
| Facility | | $426.58 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,235.94 / $3,467.37
| Facility | | $602.56 | $3,235.94 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,905.46 / $2,454.71
| Facility | | $1,122.02 | $1,905.46 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $302.00 / $2,630.27
| Facility | | $173.78 | $302.00 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,041.74 / $3,311.31
| Facility | | $831.76 | $2,041.74 | $3,311.31 |