- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,288.25 / $3,890.45
| Facility | | $501.19 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,691.53 / $3,801.89
| Facility | | $1,479.11 | $2,691.53 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $1,288.25 / $1,288.25
| Facility | | $131.83 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $812.83 / $1,258.93
| Facility | | $263.03 | $812.83 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,412.54 / $4,168.69
| Facility | | $467.74 | $1,412.54 | $4,168.69 |