- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,949.84 / $4,677.35
| Facility | | $891.25 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,332.54 / $13,182.57
| Facility | | $5,370.32 | $9,332.54 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $741.31
| Facility | | $39.81 | $39.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- 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 |