- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,691.53 / $6,025.60
| Facility | | $933.25 | $2,691.53 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,413.10 / $10,715.19
| Facility | | $3,715.35 | $7,413.10 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $4,786.30 / $4,786.30
| Facility | | $39.81 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,754.23 / $7,943.28
| Facility | | $831.76 | $2,754.23 | $7,943.28 |