- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.05 / $2,145.78 / $7,838.38
| Facility | | $486.05 | $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
- $378.82 / $378.82 / $749.86
| Facility | | $378.82 | $378.82 | $749.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.76 / $447.40 / $718.98
| Facility | | $233.76 | $447.40 | $718.98 |
- 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 |