- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.93 / $2,145.78 / $7,838.38
| Facility | | $483.93 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.93 / $6,017.73 / $9,581.71
| Facility | | $1,764.93 | $6,017.73 | $9,581.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.22 / $656.22 / $1,651.99
| Facility | | $656.22 | $656.22 | $1,651.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.63 / $485.74 / $650.11
| Facility | | $368.63 | $485.74 | $650.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $3,085.00 / $5,060.00
| Facility | | $755.00 | $3,085.00 | $5,060.00 |