- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,623.41 / $11,481.54
| Facility | | $1,380.38 | $5,623.41 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $7,079.46 / $7,413.10
| Facility | | $1,737.80 | $7,079.46 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $8,709.64 / $8,709.64
| Facility | | $1,318.26 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,318.26 / $13,182.57
| Facility | | $831.76 | $1,318.26 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,754.40 / $11,748.98
| Facility | | $2,818.38 | $5,754.40 | $11,748.98 |