- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,897.79 / $17,378.01
| Facility | | $758.58 | $4,897.79 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $41,686.94 / $46,773.51
| Facility | | $1,995.26 | $41,686.94 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $630.96 / $691.83
| Facility | | $588.84 | $630.96 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,122.02 / $1,445.44
| Facility | | $977.24 | $1,122.02 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $11,481.54 / $17,378.01
| Facility | | $5,128.61 | $11,481.54 | $17,378.01 |