- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.02 / $2,145.78 / $8,781.04
| Facility | | $573.02 | $2,145.78 | $8,781.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,410.76 / $3,384.42 / $5,388.84
| Facility | | $1,410.76 | $3,384.42 | $5,388.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.26 / $399.26 / $839.09
| Facility | | $399.26 | $399.26 | $839.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.98 / $499.13 / $766.29
| Facility | | $226.98 | $499.13 | $766.29 |
- 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 |