- 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
- $1,862.09 / $8,128.31 / $13,489.63
| Facility | | $1,862.09 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $77,624.71 / $77,624.71
| Facility | | $19,498.45 | $77,624.71 | $77,624.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,964.78 / $31,622.78
| Facility | | $6,456.54 | $10,964.78 | $31,622.78 |