- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,041.74 / $4,570.88
| Facility | | $758.58 | $2,041.74 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,888.44 / $11,481.54
| Facility | | $3,090.30 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $389.05 / $4,677.35
| Facility | | $39.81 | $389.05 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $812.83 / $7,244.36
| Facility | | $724.44 | $812.83 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $6,456.54 / $14,791.08
| Facility | | $1,122.02 | $6,456.54 | $14,791.08 |