- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $4,168.69
| Facility | | $660.69 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,238.72 / $3,630.78
| Facility | | $1,318.26 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $208.93 / $831.76
| Facility | | $39.81 | $208.93 | $831.76 |
- 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 |