- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $4,897.79 / $16,595.87
| Facility | | $426.58 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $5,495.41 / $10,471.29
| Facility | | $691.83 | $5,495.41 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $575.44 / $5,623.41
| Facility | | $257.04 | $575.44 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $208.93 / $338.84
| Facility | | $151.36 | $208.93 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,471.29
| Facility | | $616.60 | $6,309.57 | $10,471.29 |