- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,288.25 / $3,890.45
| Facility | | $302.00 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,412.54 / $2,691.53
| Facility | | $741.31 | $1,412.54 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $75.86
| Facility | | $39.81 | $39.81 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,047.13 / $2,187.76
| Facility | | $338.84 | $1,047.13 | $2,187.76 |