- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.82 / $2,145.78 / $7,838.38
| Facility | | $519.82 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.23 / $3,236.81 / $5,153.80
| Facility | | $1,349.23 | $3,236.81 | $5,153.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.58 / $130.58 / $749.86
| Facility | | $130.58 | $130.58 | $749.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.70 / $342.63 / $572.36
| Facility | | $76.70 | $342.63 | $572.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $3,085.00 / $5,156.97
| Facility | | $755.00 | $3,085.00 | $5,156.97 |