- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,549.93 / $16,595.87
| Facility | | $5,370.32 | $9,549.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $30,902.95 / $61,659.50
| Facility | | $16,982.44 | $30,902.95 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $239.88 / $416.87
| Facility | | $162.18 | $239.88 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,202.26 / $3,548.13
| Facility | | $380.19 | $1,202.26 | $3,548.13 |