- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,897.79 / $5,623.41
| Facility | | $831.76 | $4,897.79 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $13,803.84 / $19,054.61
| Facility | | $2,187.76 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $562.34
| Facility | | $549.54 | $549.54 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,025.60 / $10,715.19
| Facility | | $2,398.83 | $6,025.60 | $10,715.19 |