- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,630.27 / $6,760.83
| Facility | | $602.56 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,332.54 / $15,488.17
| Facility | | $6,025.60 | $9,332.54 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $11,481.54
| Facility | | $457.09 | $758.58 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,244.36 / $14,454.40
| Facility | | $1,949.84 | $7,244.36 | $14,454.40 |