- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,698.24 / $4,365.16
| Facility | | $660.69 | $1,698.24 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $7,079.46
| Facility | | $2,238.72 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,187.76 / $2,187.76
| Facility | | $478.63 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $812.83 / $2,041.74
| Facility | | $616.60 | $812.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,445.44 / $4,365.16
| Facility | | $467.74 | $1,445.44 | $4,365.16 |