- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $2,691.53 / $2,691.53
| Facility | | $190.55 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $251.19
| Facility | | $208.93 | $208.93 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $1,318.26
| Facility | | $331.13 | $331.13 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,754.40 / $6,760.83
| Facility | | $5,011.87 | $5,754.40 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $4,466.84
| Facility | | $1,230.27 | $1,230.27 | $4,466.84 |