- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,570.40 / $7,413.10
| Facility | | $741.31 | $2,570.40 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $660.69 / $2,754.23
| Facility | | $407.38 | $660.69 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $4,677.35
| Facility | | $1,819.70 | $2,398.83 | $4,677.35 |