- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $1,174.90 / $5,623.41
| Facility | | $190.55 | $1,174.90 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $288.40 / $812.83
| Facility | | $147.91 | $288.40 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $660.69 / $1,380.38
| Facility | | $97.72 | $660.69 | $1,380.38 |