- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,818.38 / $16,982.44
| Facility | | $741.31 | $2,818.38 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,137.96 / $2,951.21
| Facility | | $1,148.15 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $870.96 / $1,023.29
| Facility | | $676.08 | $870.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,318.26 / $1,318.26
| Facility | | $34.67 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $4,168.69 / $30,199.52
| Facility | | $537.03 | $4,168.69 | $30,199.52 |