- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $2,398.83 / $5,623.41
| Facility | | $269.15 | $2,398.83 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,513.56 / $3,235.94
| Facility | | $758.58 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,630.27 / $4,677.35
| Facility | | $2,187.76 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $389.05 / $3,090.30
| Facility | | $229.09 | $389.05 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $2,951.21
| Facility | | $1,071.52 | $1,445.44 | $2,951.21 |