- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,698.24 / $4,365.16
| Facility | | $660.69 | $1,698.24 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $12,589.25
| Facility | | $5,011.87 | $8,511.38 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $870.96
| Facility | | $39.81 | $39.81 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,248.07 / $13,182.57
| Facility | | $1,148.15 | $5,248.07 | $13,182.57 |