- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,570.40 / $7,413.10
| Facility | | $812.83 | $2,570.40 | $7,413.10 |
- 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
- $104.71 / $173.78 / $1,621.81
| Facility | | $104.71 | $173.78 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,412.54 / $2,951.21
| Facility | | $1,071.52 | $1,412.54 | $2,951.21 |