- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,897.79 / $16,595.87
| Facility | | $602.56 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,466.84 / $9,120.11
| Facility | | $2,290.87 | $4,466.84 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $1,778.28
| Facility | | $371.54 | $371.54 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $660.69 / $1,148.15
| Facility | | $457.09 | $660.69 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,220.18 / $16,982.44
| Facility | | $2,754.23 | $11,220.18 | $16,982.44 |