- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,754.23 / $12,882.50
| Facility | | $1,202.26 | $2,754.23 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $12,589.25 / $20,417.38
| Facility | | $8,128.31 | $12,589.25 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,128.61 / $14,454.40
| Facility | | $912.01 | $5,128.61 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,762.47 / $14,454.40
| Facility | | $1,949.84 | $7,762.47 | $14,454.40 |