- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,801.89 / $5,623.41
| Facility | | $691.83 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $18,197.01 / $26,302.68
| Facility | | $2,398.83 | $18,197.01 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $616.60 / $707.95
| Facility | | $588.84 | $616.60 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $6,456.54
| Facility | | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,943.28 / $10,964.78
| Facility | | $4,073.80 | $7,943.28 | $10,964.78 |