- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,162.28 / $7,943.28
| Facility | | $323.59 | $3,162.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,380.38
| Facility | | $645.65 | $870.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,096.48 / $2,454.71
| Facility | | $602.56 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $302.00 / $2,290.87
| Facility | | $112.20 | $302.00 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,445.44 / $3,311.31
| Facility | | $831.76 | $1,445.44 | $3,311.31 |