- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.03 / $2,145.78 / $7,838.38
| Facility | | $471.03 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,709.45 / $4,212.64 / $6,870.27
| Facility | | $1,709.45 | $4,212.64 | $6,870.27 |
- 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
- $162.36 / $376.77 / $608.48
| Facility | | $162.36 | $376.77 | $608.48 |
- 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 |