- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,288.25 / $3,890.45
| Facility | | $524.81 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,398.83 / $4,073.80
| Facility | | $1,445.44 | $2,398.83 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $2,818.38 / $2,818.38
| Facility | | $39.81 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $5,888.44
| Facility | | $831.76 | $2,398.83 | $5,888.44 |