- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,778.28 / $4,073.80
| Facility | | $467.74 | $1,778.28 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,513.56 / $2,238.72
| Facility | | $691.83 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $1,288.25 / $1,288.25
| Facility | | $54.95 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $15,488.17
| Facility | | $295.12 | $812.83 | $15,488.17 |