- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,288.25 / $3,981.07
| Facility | | $275.42 | $1,288.25 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,479.11 / $2,089.30
| Facility | | $616.60 | $1,479.11 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $371.54 / $1,659.59
| Facility | | $263.03 | $371.54 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $19,498.45
| Facility | | $1,995.26 | $1,995.26 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $758.58 / $2,511.89
| Facility | | $229.09 | $758.58 | $2,511.89 |