- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $6,025.60 / $16,595.87
| Facility | | $891.25 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $9,549.93
| Facility | | $2,137.96 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,691.53
| Facility | | $2,089.30 | $2,089.30 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,258.93
| Facility | | $549.54 | $758.58 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,220.18 / $16,982.44
| Facility | | $2,754.23 | $11,220.18 | $16,982.44 |