- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.92 / $3,444.89 / $5,785.25
| Facility | | $403.92 | $3,444.89 | $5,785.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.00 / $6,716.00 / $16,778.00
| Facility | | $1,058.00 | $6,716.00 | $16,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.33 / $437.58 / $504.90
| Facility | | $343.33 | $437.58 | $504.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.68 / $761.00 / $1,158.10
| Facility | | $422.68 | $761.00 | $1,158.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |