- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,918.31 / $13,489.63
| Facility | | $1,819.70 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $16,595.87 / $17,378.01
| Facility | | $3,467.37 | $16,595.87 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,137.96 / $26,302.68
| Facility | | $977.24 | $2,137.96 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,570.88 / $8,912.51
| Facility | | $1,995.26 | $4,570.88 | $8,912.51 |