- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,513.56 / $4,168.69
| Facility | | $660.69 | $1,513.56 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,467.37 / $4,786.30
| Facility | | $1,905.46 | $3,467.37 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $6,165.95
| Facility | | $831.76 | $2,630.27 | $6,165.95 |