- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,659.59 / $4,168.69
| Facility | | $588.84 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,995.26 / $3,630.78
| Facility | | $1,174.90 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,548.82 / $1,548.82
| Facility | | $213.80 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $724.44 / $1,258.93
| Facility | | $407.38 | $724.44 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,412.54 / $4,168.69
| Facility | | $467.74 | $1,412.54 | $4,168.69 |