- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,801.89 / $5,623.41
| Facility | | $891.25 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $18,197.01 / $26,302.68
| Facility | | $2,398.83 | $18,197.01 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $794.33 / $891.25
| Facility | | $758.58 | $794.33 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $1,621.81
| Facility | | $741.31 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $10,964.78
| Facility | | $4,073.80 | $7,762.47 | $10,964.78 |