- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,089.30 / $8,709.64
| Facility | | $1,995.26 | $2,089.30 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $14,125.38 / $22,387.21
| Facility | | $3,981.07 | $14,125.38 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,659.59 / $2,344.23
| Facility | | $1,380.38 | $1,659.59 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $7,762.47 / $16,982.44
| Facility | | $794.33 | $7,762.47 | $16,982.44 |