- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,801.89 / $5,623.41
| Facility | | $912.01 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $39,810.72 / $81,283.05
| Facility | | $2,691.53 | $39,810.72 | $81,283.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $812.83 / $912.01
| Facility | | $776.25 | $812.83 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $22,908.68
| Facility | | $22,908.68 | $22,908.68 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $15,848.93 / $20,417.38
| Facility | | $7,244.36 | $15,848.93 | $20,417.38 |