- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,162.28 / $6,606.93
| Facility | | $933.25 | $3,162.28 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,882.50 / $27,542.29
| Facility | | $5,011.87 | $12,882.50 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $691.83
| Facility | | $39.81 | $39.81 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $7,079.46 / $13,489.63
| Facility | | $1,202.26 | $7,079.46 | $13,489.63 |