- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,290.87 / $11,220.18
| Facility | | $602.56 | $2,290.87 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,481.54 / $19,054.61
| Facility | | $3,715.35 | $11,481.54 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $549.54 / $616.60
| Facility | | $489.78 | $549.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,511.89
| Facility | | $2,137.96 | $2,137.96 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,762.47 / $10,964.78
| Facility | | $2,691.53 | $7,762.47 | $10,964.78 |