- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $2,290.87 / $14,454.40
| Facility | | $316.23 | $2,290.87 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,398.83 / $4,365.16
| Facility | | $1,513.56 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $288.40 / $338.84
| Facility | | $204.17 | $288.40 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $1,659.59
| Facility | | $389.05 | $389.05 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,890.45 / $8,511.38
| Facility | | $741.31 | $3,890.45 | $8,511.38 |