- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,570.40 / $5,495.41
| Facility | | $891.25 | $2,570.40 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,772.37 / $13,803.84
| Facility | | $5,623.41 | $9,772.37 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $11,220.18 / $11,220.18
| Facility | | $39.81 | $11,220.18 | $11,220.18 |
- 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 / $6,456.54 / $13,489.63
| Facility | | $1,202.26 | $6,456.54 | $13,489.63 |