- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.41 / $886.53 / $1,201.20
| Facility | | $297.41 | $886.53 | $1,201.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.25 / $2,928.13 / $5,663.95
| Facility | | $2,226.25 | $2,928.13 | $5,663.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.69 / $460.97 / $1,242.00
| Facility | | $216.69 | $460.97 | $1,242.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.39 / $598.52 / $773.37
| Facility | | $366.39 | $598.52 | $773.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |