- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.10 / $7,838.38 / $7,838.38
| Facility | | $247.10 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.62 / $8,426.79 / $13,562.56
| Facility | | $1,603.62 | $8,426.79 | $13,562.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.74 / $263.74 / $1,651.99
| Facility | | $263.74 | $263.74 | $1,651.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.02 / $285.60 / $360.44
| Facility | | $220.02 | $285.60 | $360.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $6,599.00 / $7,158.00
| Facility | | $936.00 | $6,599.00 | $7,158.00 |