- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.77 / $2,145.78 / $7,838.38
| Facility | | $308.77 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.77 / $2,021.80 / $3,219.21
| Facility | | $842.77 | $2,021.80 | $3,219.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.75 / $176.75 / $749.86
| Facility | | $176.75 | $176.75 | $749.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.92 / $257.95 / $397.18
| Facility | | $101.92 | $257.95 | $397.18 |
- 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 |