- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $4,897.79 / $16,595.87
| Facility | | $562.34 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,365.16 / $7,943.28
| Facility | | $2,041.74 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $1,659.59
| Facility | | $371.54 | $371.54 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $478.63 / $812.83
| Facility | | $275.42 | $478.63 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,964.78 / $16,982.44
| Facility | | $1,995.26 | $10,964.78 | $16,982.44 |