- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,288.25 / $5,495.41
| Facility | | $371.54 | $1,288.25 | $5,495.41 |
- 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
- $245.47 / $316.23 / $371.54
| Facility | | $245.47 | $316.23 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $1,659.59
| Facility | | $467.74 | $467.74 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $954.99 / $3,388.44
| Facility | | $389.05 | $954.99 | $3,388.44 |