- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,801.89 / $7,413.10
| Facility | | $2,187.76 | $3,801.89 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,445.44 / $2,691.53
| Facility | | $549.54 | $1,445.44 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $1,023.29
| Facility | | $741.31 | $977.24 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $2,511.89
| Facility | | $251.19 | $354.81 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,698.24 / $4,677.35
| Facility | | $977.24 | $1,698.24 | $4,677.35 |