- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,897.79 / $14,125.38
| Facility | | $676.08 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $13,803.84 / $19,054.61
| Facility | | $4,365.16 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $426.58 / $489.78
| Facility | | $416.87 | $426.58 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $602.56 / $1,047.13
| Facility | | $416.87 | $602.56 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,025.60 / $10,715.19
| Facility | | $3,235.94 | $6,025.60 | $10,715.19 |