- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,290.87 / $4,073.80
| Facility | | $575.44 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,890.45 / $5,888.44
| Facility | | $1,513.56 | $3,890.45 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,659.59 / $4,073.80
| Facility | | $371.54 | $1,659.59 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $19,498.45
| Facility | | $10,715.19 | $10,715.19 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,548.13 / $6,025.60
| Facility | | $1,258.93 | $3,548.13 | $6,025.60 |