- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,309.09 / $2,521.30 / $8,763.29
| Facility | | $1,309.09 | $2,521.30 | $8,763.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,703.05 / $8,392.32 / $13,362.65
| Facility | | $2,703.05 | $8,392.32 | $13,362.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.12 / $680.12 / $1,656.16
| Facility | | $680.12 | $680.12 | $1,656.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.12 / $480.32 / $680.12
| Facility | | $333.12 | $480.32 | $680.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $6,599.00 / $7,158.00
| Facility | | $936.00 | $6,599.00 | $7,158.00 |