- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.22 / $2,145.78 / $7,838.38
| Facility | | $336.22 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.24 / $3,325.10 / $5,351.60
| Facility | | $629.24 | $3,325.10 | $5,351.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.24 / $124.24 / $596.36
| Facility | | $124.24 | $124.24 | $596.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.47 / $111.60 / $391.18
| Facility | | $72.47 | $111.60 | $391.18 |
- 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 |