- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,348.96 / $8,128.31
| Facility | | $562.34 | $1,348.96 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,801.89 / $8,511.38
| Facility | | $2,344.23 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $446.68 / $630.96
| Facility | | $363.08 | $446.68 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $707.95 / $1,862.09
| Facility | | $630.96 | $707.95 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,698.24 / $6,309.57
| Facility | | $575.44 | $1,698.24 | $6,309.57 |