- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,187.76 / $4,073.80
| Facility | | $616.60 | $2,187.76 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,073.80 / $5,888.44
| Facility | | $1,621.81 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $12,302.69
| Facility | | $2,630.27 | $2,630.27 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $28,840.32
| Facility | | $11,481.54 | $11,481.54 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,786.30 / $15,488.17
| Facility | | $2,754.23 | $4,786.30 | $15,488.17 |