- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,715.35 / $12,589.25
| Facility | | $851.14 | $3,715.35 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,709.64 / $11,220.18
| Facility | | $4,265.80 | $8,709.64 | $11,220.18 |
- 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
- $724.44 / $954.99 / $1,380.38
| Facility | | $724.44 | $954.99 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,762.47 / $10,964.78
| Facility | | $2,691.53 | $7,762.47 | $10,964.78 |