- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,570.88 / $16,218.10
| Facility | | $891.25 | $4,570.88 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $18,620.87 / $26,302.68
| Facility | | $9,549.93 | $18,620.87 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $794.33 / $891.25
| Facility | | $758.58 | $794.33 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,071.52 / $1,584.89
| Facility | | $776.25 | $1,071.52 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $7,762.47 / $10,964.78
| Facility | | $3,090.30 | $7,762.47 | $10,964.78 |