- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,949.84 / $9,120.11
| Facility | | $309.03 | $1,949.84 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,011.87 / $10,964.78
| Facility | | $2,754.23 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $245.47 / $346.74
| Facility | | $199.53 | $245.47 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $2,290.87
| Facility | | $389.05 | $389.05 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,698.24 / $6,309.57
| Facility | | $575.44 | $1,698.24 | $6,309.57 |