- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $977.24 / $977.24
| Facility | | $794.33 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $309.03 / $1,479.11
| Facility | | $134.90 | $309.03 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,137.96 / $4,073.80
| Facility | | $1,905.46 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $758.58 / $1,513.56
| Facility | | $302.00 | $758.58 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,513.56 / $2,398.83
| Facility | | $151.36 | $1,513.56 | $2,398.83 |