- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.70 / $4,995.14 / $12,246.73
| Facility | | $390.70 | $4,995.14 | $12,246.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,662.81 / $3,944.18 / $7,881.56
| Facility | | $1,662.81 | $3,944.18 | $7,881.56 |
- 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
- $291.00 / $442.13 / $698.52
| Facility | | $291.00 | $442.13 | $698.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.00 / $10,147.00 / $16,816.00
| Facility | | $2,764.00 | $10,147.00 | $16,816.00 |