- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,897.79 / $8,709.64
| Facility | | $758.58 | $4,897.79 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $13,803.84 / $19,054.61
| Facility | | $2,187.76 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $691.83 / $794.33
| Facility | | $676.08 | $691.83 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,202.26 / $2,511.89
| Facility | | $398.11 | $1,202.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,025.60 / $10,715.19
| Facility | | $2,137.96 | $6,025.60 | $10,715.19 |