- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,905.46 / $5,370.32
| Facility | | $354.81 | $1,905.46 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,884.03 / $5,495.41
| Facility | | $1,659.59 | $2,884.03 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $257.04 / $363.08
| Facility | | $208.93 | $257.04 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $1,659.59
| Facility | | $407.38 | $407.38 | $1,659.59 |
- 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 |