- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $4,897.79 / $12,882.50
| Facility | | $309.03 | $4,897.79 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $28,183.83 / $39,810.72
| Facility | | $5,128.61 | $28,183.83 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $269.15 / $309.03
| Facility | | $245.47 | $269.15 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $707.95 / $1,348.96
| Facility | | $302.00 | $707.95 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $10,964.78
| Facility | | $4,073.80 | $7,762.47 | $10,964.78 |