- 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
- $2,344.23 / $4,677.35 / $9,549.93
| Facility | | $2,344.23 | $4,677.35 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $933.25 / $2,238.72
| Facility | | $245.47 | $933.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $10,964.78 / $16,982.44
| Facility | | $2,754.23 | $10,964.78 | $16,982.44 |