- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,897.79 / $11,220.18
| Facility | | $776.25 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $18,197.01 / $26,302.68
| Facility | | $3,715.35 | $18,197.01 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $741.31 / $776.25
| Facility | | $660.69 | $741.31 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,122.02 / $2,041.74
| Facility | | $724.44 | $1,122.02 | $2,041.74 |
- 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 |