- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,128.61 / $7,413.10
| Facility | | $1,380.38 | $5,128.61 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,495.41 / $8,511.38
| Facility | | $2,884.03 | $5,495.41 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,445.44 / $5,248.07
| Facility | | $851.14 | $1,445.44 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,762.47 / $10,232.93
| Facility | | $5,888.44 | $7,762.47 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $10,232.93 / $27,542.29
| Facility | | $2,089.30 | $10,232.93 | $27,542.29 |