- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $11,220.18 / $28,840.32
| Facility | | $870.96 | $11,220.18 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $28,183.83 / $39,810.72
| Facility | | $4,168.69 | $28,183.83 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $724.44 / $812.83
| Facility | | $660.69 | $724.44 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,122.02 / $1,445.44
| Facility | | $707.95 | $1,122.02 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $11,220.18 / $17,378.01
| Facility | | $5,128.61 | $11,220.18 | $17,378.01 |