- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,344.23 / $4,897.79
| Facility | | $371.54 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $13,489.63 / $19,054.61
| Facility | | $2,089.30 | $13,489.63 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $354.81 / $371.54
| Facility | | $316.23 | $354.81 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $870.96
| Facility | | $354.81 | $588.84 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |