- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.81 / $2,145.78 / $7,838.38
| Facility | | $458.81 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.90 / $3,073.55 / $4,946.74
| Facility | | $727.90 | $3,073.55 | $4,946.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.20 / $289.20 / $749.86
| Facility | | $289.20 | $289.20 | $749.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.14 / $376.56 / $573.61
| Facility | | $175.14 | $376.56 | $573.61 |
- 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 |