- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,691.53 / $4,365.16
| Facility | | $933.25 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,964.78 / $18,620.87
| Facility | | $6,918.31 | $10,964.78 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,148.15 / $1,148.15
| Facility | | $39.81 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $2,290.87
| Facility | | $489.78 | $812.83 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $5,888.44
| Facility | | $831.76 | $2,398.83 | $5,888.44 |