- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,238.72 / $4,073.80
| Facility | | $575.44 | $2,238.72 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,089.30 / $2,951.21
| Facility | | $954.99 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $398.11 / $1,348.96
| Facility | | $331.13 | $398.11 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $19,498.45
| Facility | | $3,630.78 | $3,630.78 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,187.76 / $3,981.07
| Facility | | $912.01 | $2,187.76 | $3,981.07 |