- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,818.38 / $8,511.38
| Facility | | $794.33 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,715.19 / $11,220.18
| Facility | | $6,606.93 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $1,174.90
| Facility | | $676.08 | $831.76 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,348.96 / $1,348.96
| Facility | | $34.67 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $4,168.69 / $30,199.52
| Facility | | $407.38 | $4,168.69 | $30,199.52 |