- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,801.89 / $5,623.41
| Facility | | $645.65 | $3,801.89 | $5,623.41 |
- 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
- $562.34 / $588.84 / $676.08
| Facility | | $562.34 | $588.84 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,202.26
| Facility | | $588.84 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $7,762.47 / $10,964.78
| Facility | | $3,090.30 | $7,762.47 | $10,964.78 |