- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,456.54 / $13,489.63
| Facility | | $1,949.84 | $6,456.54 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,918.31 / $7,413.10
| Facility | | $3,090.30 | $6,918.31 | $7,413.10 |
- 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
- $741.31 / $2,691.53 / $26,302.68
| Facility | | $741.31 | $2,691.53 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,623.41 / $11,220.18
| Facility | | $2,818.38 | $5,623.41 | $11,220.18 |