- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.57 / $3,494.48 / $7,765.50
| Facility | | $412.57 | $3,494.48 | $7,765.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $11,384.53
| Facility | | $606.10 | $606.10 | $11,384.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.57 / $3,957.98 / $7,420.68
| Facility | | $356.57 | $3,957.98 | $7,420.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,061.94 / $2,061.94
| Facility | | $55.00 | $2,061.94 | $2,061.94 |