- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,344.23 / $4,897.79
| Facility | | $831.76 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $19,054.61 / $26,302.68
| Facility | | $9,549.93 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $741.31 / $831.76
| Facility | | $707.95 | $741.31 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,174.90 / $1,513.56
| Facility | | $741.31 | $1,174.90 | $1,513.56 |
- 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 |