- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,398.83 / $8,317.64
| Facility | | $616.60 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,951.21 / $3,981.07
| Facility | | $1,659.59 | $2,951.21 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $13,803.84 / $19,952.62
| Facility | | $12,302.69 | $13,803.84 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $28,840.32
| Facility | | $5,623.41 | $5,623.41 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,290.87 / $4,073.80
| Facility | | $1,202.26 | $2,290.87 | $4,073.80 |