- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $5,495.41 / $12,302.69
| Facility | | $630.96 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,570.88 / $5,011.87
| Facility | | $2,290.87 | $4,570.88 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $758.58 / $6,456.54
| Facility | | $489.78 | $758.58 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,884.03 / $4,677.35
| Facility | | $1,548.82 | $2,884.03 | $4,677.35 |