- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.06 / $5,192.00 / $12,532.61
| Facility | | $149.06 | $5,192.00 | $12,532.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.83 / $1,220.26 / $2,180.11
| Facility | | $604.83 | $1,220.26 | $2,180.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,099.52 / $1,099.52 / $1,412.91
| Facility | | $1,099.52 | $1,099.52 | $1,412.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.66 / $763.64 / $1,199.18
| Facility | | $139.66 | $763.64 | $1,199.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.00 / $6,679.00 / $9,951.00
| Facility | | $1,471.00 | $6,679.00 | $9,951.00 |