- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,951.21 / $6,760.83
| Facility | | $891.25 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $8,128.31 / $12,882.50
| Facility | | $5,248.07 | $8,128.31 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,862.09 / $10,232.93
| Facility | | $676.08 | $1,862.09 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |