- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $2,754.23 / $7,585.78
| Facility | | $257.04 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $1,096.48
| Facility | | $602.56 | $602.56 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $831.76 / $1,737.80
| Facility | | $147.91 | $831.76 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,445.44 / $3,311.31
| Facility | | $831.76 | $1,445.44 | $3,311.31 |