- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,019.95 / $7,244.36
| Facility | | $891.25 | $3,019.95 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $2,754.23 / $2,754.23
| Facility | | $39.81 | $2,754.23 | $2,754.23 |
- 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
- $831.76 / $2,630.27 / $6,606.93
| Facility | | $831.76 | $2,630.27 | $6,606.93 |