- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,570.40 / $8,128.31
| Facility | | $831.76 | $2,570.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,623.41 / $12,882.50
| Facility | | $2,344.23 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $13,489.63 / $25,703.96
| Facility | | $10,232.93 | $13,489.63 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $912.01 / $12,589.25
| Facility | | $154.88 | $912.01 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $1,412.54
| Facility | | $338.84 | $707.95 | $1,412.54 |