- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,456.54 / $18,620.87
| Facility | | $2,398.83 | $6,456.54 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $15,135.61 / $16,218.10
| Facility | | $12,882.50 | $15,135.61 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $12,882.50 / $12,882.50
| Facility | | $630.96 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,862.09 / $15,135.61
| Facility | | $1,148.15 | $1,862.09 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,471.29 / $18,620.87
| Facility | | $3,311.31 | $10,471.29 | $18,620.87 |