- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,495.41 / $26,302.68
| Facility | | $977.24 | $5,495.41 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $21,379.62 / $26,915.35
| Facility | | $12,589.25 | $21,379.62 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $27,542.29 / $33,884.42
| Facility | | $22,908.68 | $27,542.29 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $5,888.44 / $17,378.01
| Facility | | $575.44 | $5,888.44 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,964.78 / $17,378.01
| Facility | | $2,951.21 | $10,964.78 | $17,378.01 |