- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,041.74 / $5,623.41
| Facility | | $389.05 | $2,041.74 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $6,918.31
| Facility | | $2,238.72 | $4,570.88 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $1,995.26 / $1,995.26
| Facility | | $107.15 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $724.44 / $1,949.84
| Facility | | $199.53 | $724.44 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $6,309.57
| Facility | | $831.76 | $2,398.83 | $6,309.57 |