- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,691.53 / $6,606.93
| Facility | | $741.31 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,888.44 / $10,715.19
| Facility | | $2,691.53 | $5,888.44 | $10,715.19 |
- 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
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,623.41 / $12,302.69
| Facility | | $1,202.26 | $5,623.41 | $12,302.69 |