- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,344.23 / $11,481.54
| Facility | | $794.33 | $2,344.23 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $28,183.83 / $39,810.72
| Facility | | $2,884.03 | $28,183.83 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $724.44 / $812.83
| Facility | | $645.65 | $724.44 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $1,621.81
| Facility | | $707.95 | $1,071.52 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $10,964.78
| Facility | | $4,073.80 | $7,762.47 | $10,964.78 |