- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,089.30 / $5,623.41
| Facility | | $724.44 | $2,089.30 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $6,918.31
| Facility | | $2,238.72 | $4,570.88 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,754.23 / $2,754.23
| Facility | | $398.11 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $812.83 / $2,041.74
| Facility | | $676.08 | $812.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $6,309.57
| Facility | | $831.76 | $2,398.83 | $6,309.57 |