- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.69 / $2,145.78 / $7,838.38
| Facility | | $513.69 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.02 / $2,667.74 / $4,247.71
| Facility | | $1,112.02 | $2,667.74 | $4,247.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.22 / $578.22 / $3,456.15
| Facility | | $578.22 | $578.22 | $3,456.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.58 / $455.04 / $619.51
| Facility | | $328.58 | $455.04 | $619.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $6,599.00 / $7,158.00
| Facility | | $936.00 | $6,599.00 | $7,158.00 |