- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,344.23 / $4,897.79
| Facility | | $630.96 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $19,952.62 / $27,542.29
| Facility | | $8,317.64 | $19,952.62 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $602.56 / $645.65
| Facility | | $549.54 | $602.56 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $933.25 / $1,412.54
| Facility | | $602.56 | $933.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $11,220.18 / $17,378.01
| Facility | | $4,570.88 | $11,220.18 | $17,378.01 |