- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,897.79 / $11,220.18
| Facility | | $676.08 | $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
- $616.60 / $676.08 / $776.25
| Facility | | $616.60 | $676.08 | $776.25 |
- 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 / $10,964.78 / $17,378.01
| Facility | | $2,691.53 | $10,964.78 | $17,378.01 |