- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.09 / $7,838.38 / $7,838.38
| Facility | | $622.09 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,345.93 / $15,048.81 / $23,961.46
| Facility | | $4,345.93 | $15,048.81 | $23,961.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.68 / $773.68 / $3,456.15
| Facility | | $773.68 | $773.68 | $3,456.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.95 / $606.05 / $901.17
| Facility | | $460.95 | $606.05 | $901.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.00 / $11,259.00 / $12,494.00
| Facility | | $1,705.00 | $11,259.00 | $12,494.00 |