- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,162.28 / $7,943.28
| Facility | | $1,096.48 | $3,162.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $12,589.25 / $27,542.29
| Facility | | $5,623.41 | $12,589.25 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $1,288.25
| Facility | | $39.81 | $39.81 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $9,772.37 / $25,703.96
| Facility | | $1,202.26 | $9,772.37 | $25,703.96 |