- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,801.89 / $5,623.41
| Facility | | $831.76 | $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
- $616.60 / $676.08 / $776.25
| Facility | | $616.60 | $676.08 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $1,548.82
| Facility | | $707.95 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,137.96 / $5,754.40
| Facility | | $977.24 | $2,137.96 | $5,754.40 |