- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,570.40 / $5,888.44
| Facility | | $891.25 | $2,570.40 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,413.10 / $14,125.38
| Facility | | $4,073.80 | $7,413.10 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $602.56
| Facility | | $39.81 | $39.81 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- 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 |