- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,137.96 / $4,073.80
| Facility | | $575.44 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,818.38 / $3,801.89
| Facility | | $1,513.56 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $19,498.45
| Facility | | $5,495.41 | $5,495.41 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,630.78 / $6,309.57
| Facility | | $1,995.26 | $3,630.78 | $6,309.57 |