- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,513.56 / $5,495.41
| Facility | | $338.84 | $1,513.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,398.83 / $4,365.16
| Facility | | $1,479.11 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $524.81
| Facility | | $295.12 | $407.38 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $1,659.59
| Facility | | $549.54 | $549.54 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,445.44 / $5,248.07
| Facility | | $524.81 | $1,445.44 | $5,248.07 |