- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,691.53 / $5,370.32
| Facility | | $891.25 | $2,691.53 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $1,584.89 / $6,456.54
| Facility | | $0.02 | $1,584.89 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $512.86 / $1,258.93
| Facility | | $208.93 | $512.86 | $1,258.93 |