- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.78 / $4,241.22 / $13,841.56
| Facility | | $543.78 | $4,241.22 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,335.87 / $4,520.96 / $8,486.99
| Facility | | $3,335.87 | $4,520.96 | $8,486.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.65 / $235.06 / $655.48
| Facility | | $165.65 | $235.06 | $655.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.81 / $396.00 / $517.78
| Facility | | $306.81 | $396.00 | $517.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.00 / $1,527.00 / $4,317.00
| Facility | | $1,056.00 | $1,527.00 | $4,317.00 |