- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.32 / $2,145.78 / $7,838.38
| Facility | | $900.32 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.43 / $3,145.54 / $5,129.97
| Facility | | $1,276.43 | $3,145.54 | $5,129.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.55 / $247.55 / $1,023.75
| Facility | | $247.55 | $247.55 | $1,023.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.60 / $686.39 / $1,490.20
| Facility | | $139.60 | $686.39 | $1,490.20 |
- 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 |