- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,570.40 / $5,370.32
| Facility | | $870.96 | $2,570.40 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,549.93 / $13,489.63
| Facility | | $5,495.41 | $9,549.93 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $616.60
| Facility | | $39.81 | $39.81 | $616.60 |
- 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
- $1,148.15 / $5,370.32 / $11,748.98
| Facility | | $1,148.15 | $5,370.32 | $11,748.98 |