- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.13 / $2,145.78 / $7,838.38
| Facility | | $402.13 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.15 / $2,952.41 / $4,751.77
| Facility | | $864.15 | $2,952.41 | $4,751.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.79 / $172.79 / $1,023.75
| Facility | | $172.79 | $172.79 | $1,023.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.56 / $300.06 / $423.84
| Facility | | $106.56 | $300.06 | $423.84 |
- 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 |