- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,570.40 / $5,754.40
| Facility | | $831.76 | $2,570.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,897.79 / $7,413.10
| Facility | | $2,630.27 | $4,897.79 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $2,511.89 / $2,511.89
| Facility | | $39.81 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,467.37 / $8,511.38
| Facility | | $1,023.29 | $3,467.37 | $8,511.38 |