- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.78 / $2,145.78 / $7,838.38
| Facility | | $531.78 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,247.63 / $5,425.42 / $9,033.20
| Facility | | $2,247.63 | $5,425.42 | $9,033.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.50 / $315.50 / $394.32
| Facility | | $315.50 | $315.50 | $394.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.95 / $430.59 / $683.03
| Facility | | $175.95 | $430.59 | $683.03 |
- 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 |