- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $4,365.16
| Facility | | $660.69 | $1,659.59 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,413.10 / $13,803.84
| Facility | | $4,073.80 | $7,413.10 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $5,623.41 / $5,623.41
| Facility | | $39.81 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,548.13 / $10,964.78
| Facility | | $1,023.29 | $3,548.13 | $10,964.78 |