- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $6,165.95 / $26,302.68
| Facility | | $389.05 | $6,165.95 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $446.68
| Facility | | $371.54 | $371.54 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $2,290.87
| Facility | | $602.56 | $602.56 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,498.45
| Facility | | $19,054.61 | $19,054.61 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $9,772.37
| Facility | | $2,454.71 | $2,454.71 | $9,772.37 |