- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,630.27 / $5,888.44
| Facility | | $891.25 | $2,630.27 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,073.80 / $6,309.57
| Facility | | $1,995.26 | $4,073.80 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,570.40 / $6,165.95
| Facility | | $831.76 | $2,570.40 | $6,165.95 |