- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $8,511.38
| Facility | | $851.14 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,715.19 / $15,135.61
| Facility | | $8,912.51 | $10,715.19 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,995.26 / $2,754.23
| Facility | | $1,621.81 | $1,995.26 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $3,162.28 / $3,162.28
| Facility | | $34.67 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,570.40 / $15,135.61
| Facility | | $851.14 | $2,570.40 | $15,135.61 |