- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,456.54 / $11,481.54
| Facility | | $2,238.72 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,413.10 / $7,413.10
| Facility | | $7,079.46 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,511.89 / $8,511.38
| Facility | | $1,380.38 | $2,511.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,677.35 / $8,912.51
| Facility | | $1,995.26 | $4,677.35 | $8,912.51 |