- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,089.30 / $4,897.79
| Facility | | $891.25 | $2,089.30 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,311.31 / $5,011.87
| Facility | | $1,659.59 | $3,311.31 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $660.69
| Facility | | $39.81 | $39.81 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $5,888.44
| Facility | | $831.76 | $2,398.83 | $5,888.44 |