- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $2,398.83 / $5,754.40
| Facility | | $162.18 | $2,398.83 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $147.91 / $741.31
| Facility | | $91.20 | $147.91 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $1,778.28
| Facility | | $338.84 | $707.95 | $1,778.28 |