- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,019.95 / $6,025.60
| Facility | | $933.25 | $3,019.95 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,471.29 / $15,848.93
| Facility | | $6,025.60 | $10,471.29 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $7,585.78 / $7,585.78
| Facility | | $39.81 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- 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 |