- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.51 / $3,165.05 / $11,833.25
| Facility | | $299.51 | $3,165.05 | $11,833.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.94 / $6,832.28 / $12,206.55
| Facility | | $2,369.94 | $6,832.28 | $12,206.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,808.49 / $2,808.49 / $3,608.96
| Facility | | $2,808.49 | $2,808.49 | $3,608.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.51 / $933.06 / $1,377.37
| Facility | | $244.51 | $933.06 | $1,377.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |