- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $7,244.36 / $16,595.87
| Facility | | $691.83 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,888.44 / $10,232.93
| Facility | | $2,398.83 | $5,888.44 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,041.74 / $2,630.27
| Facility | | $501.19 | $2,041.74 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $676.08
| Facility | | $251.19 | $380.19 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $13,182.57 / $23,988.33
| Facility | | $5,128.61 | $13,182.57 | $23,988.33 |