- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,089.30 / $4,897.79
| Facility | | $891.25 | $2,089.30 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,317.64 / $13,803.84
| Facility | | $4,466.84 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,011.87 / $11,220.18
| Facility | | $1,148.15 | $5,011.87 | $11,220.18 |