- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,290.87 / $8,511.38
| Facility | | $741.31 | $2,290.87 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,801.89 / $8,511.38
| Facility | | $2,290.87 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $933.25 / $1,122.02
| Facility | | $676.08 | $933.25 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,047.13 / $1,258.93
| Facility | | $34.67 | $1,047.13 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |