- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $4,897.79 / $7,244.36
| Facility | | $588.84 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,803.84 / $19,054.61
| Facility | | $2,344.23 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $398.11 / $446.68
| Facility | | $380.19 | $398.11 | $446.68 |
- 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 |