- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.72 / $2,145.78 / $7,838.38
| Facility | | $916.72 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.13 / $2,087.46 / $3,323.75
| Facility | | $870.13 | $2,087.46 | $3,323.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.88 / $145.88 / $1,023.75
| Facility | | $145.88 | $145.88 | $1,023.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.62 / $285.64 / $964.33
| Facility | | $89.62 | $285.64 | $964.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $3,085.00 / $8,296.90
| Facility | | $755.00 | $3,085.00 | $8,296.90 |