- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,949.84 / $9,120.11
| Facility | | $977.24 | $1,949.84 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,073.80 / $9,549.93
| Facility | | $2,454.71 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $1,584.89
| Facility | | $977.24 | $1,230.27 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $2,290.87
| Facility | | $1,819.70 | $1,819.70 | $2,290.87 |
- 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 |