- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,691.53 / $5,888.44
| Facility | | $891.25 | $2,691.53 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $9,772.37 / $14,125.38
| Facility | | $5,754.40 | $9,772.37 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $3,388.44 / $3,388.44
| Facility | | $39.81 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $6,456.54 / $13,489.63
| Facility | | $1,202.26 | $6,456.54 | $13,489.63 |