- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,548.82 / $4,168.69
| Facility | | $537.03 | $1,548.82 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,041.74 / $3,630.78
| Facility | | $1,174.90 | $2,041.74 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $134.90 / $831.76
| Facility | | $39.81 | $134.90 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $724.44 / $1,258.93
| Facility | | $263.03 | $724.44 | $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 |