- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,818.38 / $10,471.29
| Facility | | $501.19 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $12,022.64
| Facility | | $2,884.03 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $338.84 / $407.38
| Facility | | $245.47 | $338.84 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $2,511.89
| Facility | | $457.09 | $457.09 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |