- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,570.40 / $6,456.54
| Facility | | $1,096.48 | $2,570.40 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,888.44 / $9,772.37
| Facility | | $1,949.84 | $5,888.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,258.93 / $6,165.95
| Facility | | $501.19 | $1,258.93 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $16,218.10 / $16,218.10
| Facility | | $54.95 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,413.10 / $12,022.64
| Facility | | $3,019.95 | $7,413.10 | $12,022.64 |