- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $4,897.79 / $11,220.18
| Facility | | $371.54 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $13,803.84 / $19,054.61
| Facility | | $6,309.57 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $331.13 / $380.19
| Facility | | $323.59 | $331.13 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,025.60 / $10,715.19
| Facility | | $2,884.03 | $6,025.60 | $10,715.19 |