- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,623.41 / $12,302.69
| Facility | | $1,318.26 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $2,187.76
| Facility | | $1,122.02 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $831.76 / $6,309.57
| Facility | | $588.84 | $831.76 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,818.38 / $6,309.57
| Facility | | $1,778.28 | $2,818.38 | $6,309.57 |