- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,454.71 / $5,370.32
| Facility | | $891.25 | $2,454.71 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $12,302.69 / $27,542.29
| Facility | | $4,073.80 | $12,302.69 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $14,125.38 / $14,125.38
| Facility | | $39.81 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,548.13 / $15,488.17
| Facility | | $1,023.29 | $3,548.13 | $15,488.17 |