- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $2,238.72 / $10,715.19
| Facility | | $229.09 | $2,238.72 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,137.96 / $3,981.07
| Facility | | $707.95 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $173.78
| Facility | | $147.91 | $147.91 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $295.12 / $21,379.62
| Facility | | $194.98 | $295.12 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $870.96
| Facility | | $100.00 | $100.00 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,862.09 / $4,073.80
| Facility | | $954.99 | $1,862.09 | $4,073.80 |