- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.30 / $3,006.67 / $5,439.70
| Facility | | $688.30 | $3,006.67 | $5,439.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.24 / $842.52 / $1,675.01
| Facility | | $453.24 | $842.52 | $1,675.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.13 / $384.55 / $554.03
| Facility | | $239.13 | $384.55 | $554.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.66 / $4,901.45 / $16,394.00
| Facility | | $1,329.66 | $4,901.45 | $16,394.00 |