- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,513.56 / $5,495.41
| Facility | | $338.84 | $1,513.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,235.94 / $15,848.93
| Facility | | $1,584.89 | $3,235.94 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $302.00 / $363.08
| Facility | | $218.78 | $302.00 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $1,659.59
| Facility | | $416.87 | $416.87 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |