- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,548.13 / $7,585.78
| Facility | | $1,380.38 | $3,548.13 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,365.16 / $6,309.57
| Facility | | $2,344.23 | $4,365.16 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $33,884.42
| Facility | | $8,912.51 | $8,912.51 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,290.87 / $4,073.80
| Facility | | $1,202.26 | $2,290.87 | $4,073.80 |