- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,570.40 / $6,025.60
| Facility | | $933.25 | $2,570.40 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $12,882.50 / $27,542.29
| Facility | | $6,456.54 | $12,882.50 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $16,595.87 / $16,595.87
| Facility | | $39.81 | $16,595.87 | $16,595.87 |
- 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
- $1,202.26 / $7,079.46 / $16,218.10
| Facility | | $1,202.26 | $7,079.46 | $16,218.10 |