- 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
- $3,890.45 / $7,079.46 / $14,454.40
| Facility | | $3,890.45 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $5,888.44 / $5,888.44
| Facility | | $39.81 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,754.23 / $8,912.51
| Facility | | $831.76 | $2,754.23 | $8,912.51 |