- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,905.46 / $4,570.88
| Facility | | $831.76 | $1,905.46 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $13,803.84
| Facility | | $5,623.41 | $9,549.93 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $660.69
| Facility | | $39.81 | $39.81 | $660.69 |
- 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
- $831.76 / $2,754.23 / $8,912.51
| Facility | | $831.76 | $2,754.23 | $8,912.51 |