- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,897.79 / $16,218.10
| Facility | | $933.25 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $14,125.38 / $19,054.61
| Facility | | $4,570.88 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $630.96 / $707.95
| Facility | | $562.34 | $630.96 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $9,549.93 / $16,218.10
| Facility | | $2,691.53 | $9,549.93 | $16,218.10 |