- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,691.53 / $6,606.93
| Facility | | $891.25 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,754.40 / $10,471.29
| Facility | | $2,630.27 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $2,570.40 / $2,570.40
| Facility | | $39.81 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,786.30 / $10,964.78
| Facility | | $1,148.15 | $4,786.30 | $10,964.78 |