- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.26 / $6,655.93 / $11,196.22
| Facility | | $537.26 | $6,655.93 | $11,196.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,435.81 / $4,957.82 / $8,656.54
| Facility | | $2,435.81 | $4,957.82 | $8,656.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.49 / $2,345.00 / $2,581.96
| Facility | | $749.49 | $2,345.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.72 / $697.25 / $1,165.32
| Facility | | $488.72 | $697.25 | $1,165.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |