- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,897.79 / $10,471.29
| Facility | | $954.99 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $6,918.31 / $7,244.36
| Facility | | $1,862.09 | $6,918.31 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,691.53 / $26,302.68
| Facility | | $478.63 | $2,691.53 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,623.41 / $11,220.18
| Facility | | $2,818.38 | $5,623.41 | $11,220.18 |