- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,454.71 / $6,456.54
| Facility | | $870.96 | $2,454.71 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,981.07 / $5,888.44
| Facility | | $1,659.59 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $3,019.95
| Facility | | $630.96 | $912.01 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $33,884.42
| Facility | | $7,943.28 | $7,943.28 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,548.13 / $6,025.60
| Facility | | $1,174.90 | $3,548.13 | $6,025.60 |