- 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
- $2,187.76 / $8,317.64 / $10,471.29
| Facility | | $2,187.76 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $467.74 / $524.81
| Facility | | $426.58 | $467.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $831.76 / $1,445.44
| Facility | | $549.54 | $831.76 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $6,025.60 / $10,715.19
| Facility | | $1,621.81 | $6,025.60 | $10,715.19 |