- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.71 / $2,145.78 / $7,838.38
| Facility | | $718.71 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,328.81 / $3,187.83 / $5,075.81
| Facility | | $1,328.81 | $3,187.83 | $5,075.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.20 / $386.20 / $749.86
| Facility | | $386.20 | $386.20 | $749.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.97 / $560.50 / $793.22
| Facility | | $237.97 | $560.50 | $793.22 |
- 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 |