- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,949.84 / $4,570.88
| Facility | | $758.58 | $1,949.84 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $14,125.38
| Facility | | $5,623.41 | $9,549.93 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- 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 |