- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.03 / $1,568.87 / $1,568.87
| Facility | | $105.03 | $1,568.87 | $1,568.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.94 / $4,408.18 / $16,072.37
| Facility | | $418.94 | $4,408.18 | $16,072.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,434.75 / $4,910.27 / $11,717.62
| Facility | | $3,434.75 | $4,910.27 | $11,717.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,704.53 / $4,453.18 / $9,226.48
| Facility | | $2,704.53 | $4,453.18 | $9,226.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.31 / $2,282.81 / $10,533.00
| Facility | | $162.31 | $2,282.81 | $10,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $9,793.00 / $11,531.00
| Facility | | $3,940.00 | $9,793.00 | $11,531.00 |