- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,187.76 / $4,073.80
| Facility | | $467.74 | $2,187.76 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,513.56 / $2,238.72
| Facility | | $724.44 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $3,311.31
| Facility | | $575.44 | $575.44 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,884.03 / $2,884.03
| Facility | | $54.95 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,445.44 / $2,884.03
| Facility | | $741.31 | $1,445.44 | $2,884.03 |