- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $4,897.79 / $11,220.18
| Facility | | $588.84 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $13,803.84 / $19,054.61
| Facility | | $3,715.35 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $537.03 / $602.56
| Facility | | $489.78 | $537.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,047.13 / $1,621.81
| Facility | | $562.34 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |