- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,265.80 / $12,022.64
| Facility | | $1,258.93 | $4,265.80 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,897.79 / $12,022.64
| Facility | | $2,344.23 | $4,897.79 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $13,182.57 / $17,782.79
| Facility | | $11,481.54 | $13,182.57 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,754.23 / $7,943.28
| Facility | | $1,148.15 | $2,754.23 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,818.38 / $10,964.78
| Facility | | $1,288.25 | $2,818.38 | $10,964.78 |