- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,137.96 / $11,220.18
| Facility | | $812.83 | $2,137.96 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,454.40 / $19,498.45
| Facility | | $6,456.54 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $676.08 / $758.58
| Facility | | $602.56 | $676.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $891.25 / $1,445.44
| Facility | | $676.08 | $891.25 | $1,445.44 |
- 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 |