- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,318.26 / $3,890.45
| Facility | | $501.19 | $1,318.26 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,388.44 / $5,248.07
| Facility | | $1,698.24 | $3,388.44 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $2,137.96 / $2,137.96
| Facility | | $173.78 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $812.83 / $2,041.74
| Facility | | $331.13 | $812.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,445.44 / $4,365.16
| Facility | | $467.74 | $1,445.44 | $4,365.16 |