- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,709.64 / $13,803.84
| Facility | | $2,290.87 | $8,709.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,023.29
| Facility | | $812.83 | $812.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,318.26 / $1,318.26
| Facility | | $34.67 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $13,803.84 / $39,810.72
| Facility | | $11,481.54 | $13,803.84 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $16,982.44
| Facility | | $4,466.84 | $4,466.84 | $16,982.44 |