- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $6,606.93 / $9,772.37
| Facility | | $501.19 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,570.88 / $8,317.64
| Facility | | $2,137.96 | $4,570.88 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,137.96 / $2,754.23
| Facility | | $501.19 | $2,137.96 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $257.04 / $457.09
| Facility | | $169.82 | $257.04 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,220.18 / $16,982.44
| Facility | | $2,754.23 | $11,220.18 | $16,982.44 |