- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,288.25 / $3,890.45
| Facility | | $239.88 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $2,951.21
| Facility | | $1,348.96 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $109.65 / $151.36
| Facility | | $89.13 | $109.65 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $1,318.26
| Facility | | $173.78 | $173.78 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,348.96 / $5,248.07
| Facility | | $524.81 | $1,348.96 | $5,248.07 |