- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,570.40 / $16,218.10
| Facility | | $891.25 | $2,570.40 | $16,218.10 |
- 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
- $724.44 / $794.33 / $912.01
| Facility | | $724.44 | $794.33 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $1,778.28
| Facility | | $870.96 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,220.18 / $17,378.01
| Facility | | $5,011.87 | $11,220.18 | $17,378.01 |