- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $6,606.93 / $6,606.93
| Facility | | $851.14 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,122.02
| Facility | | $933.25 | $933.25 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $2,511.89
| Facility | | $1,479.11 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,095.73 / $63,095.73 / $69,183.10
| Facility | | $63,095.73 | $63,095.73 | $69,183.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $35,481.34
| Facility | | $3,548.13 | $3,548.13 | $35,481.34 |