- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,454.71 / $6,456.54
| Facility | | $891.25 | $2,454.71 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,471.29 / $16,595.87
| Facility | | $2,454.71 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $22,387.21 / $22,387.21
| Facility | | $22,387.21 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $95,499.26 / $95,499.26
| Facility | | $45,708.82 | $95,499.26 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $14,125.38 / $26,302.68
| Facility | | $8,128.31 | $14,125.38 | $26,302.68 |