- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,162.28 / $7,413.10
| Facility | | $295.12 | $3,162.28 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,548.82 / $3,235.94
| Facility | | $758.58 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,630.27 / $4,677.35
| Facility | | $2,454.71 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $398.11 / $2,290.87
| Facility | | $245.47 | $398.11 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $3,019.95
| Facility | | $1,071.52 | $1,445.44 | $3,019.95 |