- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,365.16 / $16,595.87
| Facility | | $891.25 | $4,365.16 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $28,183.83 / $39,810.72
| Facility | | $5,128.61 | $28,183.83 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $954.99
| Facility | | $676.08 | $831.76 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $7,244.36
| Facility | | $6,165.95 | $6,165.95 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,549.93 / $16,218.10
| Facility | | $4,466.84 | $9,549.93 | $16,218.10 |