- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $6,456.54 / $12,022.64
| Facility | | $812.83 | $6,456.54 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,365.16 / $8,128.31
| Facility | | $1,819.70 | $4,365.16 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,137.96 / $2,754.23
| Facility | | $371.54 | $2,137.96 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $707.95
| Facility | | $302.00 | $416.87 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,220.18 / $16,982.44
| Facility | | $2,754.23 | $11,220.18 | $16,982.44 |