- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.43 / $2,145.78 / $7,838.38
| Facility | | $288.43 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.43 / $3,062.18 / $4,875.76
| Facility | | $1,276.43 | $3,062.18 | $4,875.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.38 / $174.38 / $1,023.75
| Facility | | $174.38 | $174.38 | $1,023.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.62 / $261.52 / $410.16
| Facility | | $107.62 | $261.52 | $410.16 |
- 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 |