- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $3,801.89 / $9,772.37
| Facility | | $257.04 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,162.28 / $6,918.31
| Facility | | $524.81 | $3,162.28 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $1,778.28
| Facility | | $331.13 | $562.34 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $275.42 / $446.68
| Facility | | $194.98 | $275.42 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,471.29
| Facility | | $616.60 | $6,309.57 | $10,471.29 |