- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,570.40 / $4,897.79
| Facility | | $776.25 | $2,570.40 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,248.07 / $7,943.28
| Facility | | $2,630.27 | $5,248.07 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $7,762.47 / $7,762.47
| Facility | | $39.81 | $7,762.47 | $7,762.47 |
- 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
- $1,202.26 / $5,623.41 / $12,302.69
| Facility | | $1,202.26 | $5,623.41 | $12,302.69 |