- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,819.70 / $4,073.80
| Facility | | $467.74 | $1,819.70 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,089.30 / $2,951.21
| Facility | | $954.99 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $691.83 / $1,445.44
| Facility | | $371.54 | $691.83 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $19,498.45
| Facility | | $3,630.78 | $3,630.78 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,187.76 / $3,981.07
| Facility | | $954.99 | $2,187.76 | $3,981.07 |