- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,818.38 / $10,715.19
| Facility | | $891.25 | $2,818.38 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,715.19 / $11,220.18
| Facility | | $7,244.36 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $1,621.81
| Facility | | $912.01 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,698.24 / $1,698.24
| Facility | | $34.67 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,011.87 / $12,302.69
| Facility | | $977.24 | $5,011.87 | $12,302.69 |