- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,288.25 / $5,495.41
| Facility | | $309.03 | $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
- $223.87 / $281.84 / $331.13
| Facility | | $223.87 | $281.84 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $426.58 / $1,659.59
| Facility | | $371.54 | $426.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,949.84 / $6,309.57
| Facility | | $602.56 | $1,949.84 | $6,309.57 |