- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,760.83 / $12,302.69
| Facility | | $1,949.84 | $6,760.83 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,238.72 / $2,290.87
| Facility | | $2,089.30 | $2,238.72 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $11,748.98
| Facility | | $11,748.98 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,089.30 / $26,302.68
| Facility | | $1,122.02 | $2,089.30 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,715.35 / $8,912.51
| Facility | | $1,995.26 | $3,715.35 | $8,912.51 |