- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.19 / $2,145.78 / $7,838.38
| Facility | | $195.19 | $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
- $139.34 / $139.34 / $579.87
| Facility | | $139.34 | $139.34 | $579.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.53 / $181.25 / $255.89
| Facility | | $116.53 | $181.25 | $255.89 |
- 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 |