- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,754.23 / $6,760.83
| Facility | | $1,047.13 | $2,754.23 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $19,952.62 / $28,840.32
| Facility | | $11,748.98 | $19,952.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $13,182.57 / $13,182.57
| Facility | | $39.81 | $13,182.57 | $13,182.57 |
- 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 / $10,232.93 / $25,703.96
| Facility | | $1,202.26 | $10,232.93 | $25,703.96 |