- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.07 / $5,997.97 / $16,087.68
| Facility | | $289.07 | $5,997.97 | $16,087.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,030.70 / $4,454.43 / $7,943.74
| Facility | | $2,030.70 | $4,454.43 | $7,943.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $2,130.29 / $2,737.46
| Facility | | $505.00 | $2,130.29 | $2,737.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.24 / $153.00 / $232.59
| Facility | | $99.24 | $153.00 | $232.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,918.00 / $16,772.00
| Facility | | $1,981.00 | $10,918.00 | $16,772.00 |