- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,897.79 / $16,218.10
| Facility | | $616.60 | $4,897.79 | $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
- $537.03 / $549.54 / $630.96
| Facility | | $537.03 | $549.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $1,071.52
| Facility | | $549.54 | $870.96 | $1,071.52 |
- 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 |