- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $4,897.79 / $11,220.18
| Facility | | $363.08 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $41,686.94 / $57,543.99
| Facility | | $11,220.18 | $41,686.94 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $338.84 / $371.54
| Facility | | $316.23 | $338.84 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Facility | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $14,454.40 / $24,547.09
| Facility | | $6,918.31 | $14,454.40 | $24,547.09 |