- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,862.09 / $5,623.41
| Facility | | $288.40 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,265.80 / $8,317.64
| Facility | | $2,089.30 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $263.03 / $302.00
| Facility | | $257.04 | $263.03 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Facility | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,137.96 / $5,754.40
| Facility | | $426.58 | $2,137.96 | $5,754.40 |