- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,309.57 / $13,182.57
| Facility | | $2,041.74 | $6,309.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,691.53 / $4,073.80
| Facility | | $1,949.84 | $2,691.53 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,513.56 / $26,302.68
| Facility | | $851.14 | $1,513.56 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,089.30 / $4,677.35
| Facility | | $1,513.56 | $2,089.30 | $4,677.35 |