- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.33 / $2,145.78 / $7,838.38
| Facility | | $430.33 | $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
- $221.30 / $221.30 / $1,023.75
| Facility | | $221.30 | $221.30 | $1,023.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.28 / $196.70 / $498.58
| Facility | | $128.28 | $196.70 | $498.58 |
- 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 |