- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,630.27 / $6,456.54
| Facility | | $891.25 | $2,630.27 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,398.83 / $4,677.35
| Facility | | $1,023.29 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $524.81 / $2,570.40
| Facility | | $501.19 | $524.81 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $12,022.64
| Facility | | $2,818.38 | $2,818.38 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,454.71 / $4,677.35
| Facility | | $1,023.29 | $2,454.71 | $4,677.35 |