- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,897.79 / $16,218.10
| Facility | | $676.08 | $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
- $407.38 / $446.68 / $512.86
| Facility | | $407.38 | $446.68 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $691.83 / $1,096.48
| Facility | | $436.52 | $691.83 | $1,096.48 |
- 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 |