- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.66 / $6,187.17 / $11,911.96
| Facility | | $500.66 | $6,187.17 | $11,911.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,625.19 / $3,822.90 / $7,710.91
| Facility | | $1,625.19 | $3,822.90 | $7,710.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.29 / $2,130.29 / $2,737.46
| Facility | | $2,130.29 | $2,130.29 | $2,737.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.00 / $484.11 / $851.12
| Facility | | $363.00 | $484.11 | $851.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |