- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,511.89 / $4,897.79
| Facility | | $891.25 | $2,511.89 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,125.38 / $19,952.62
| Facility | | $8,912.51 | $14,125.38 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,047.13 / $1,047.13
| Facility | | $39.81 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $1,905.46
| Facility | | $489.78 | $812.83 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $6,456.54 / $16,218.10
| Facility | | $1,122.02 | $6,456.54 | $16,218.10 |