- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,309.57 / $13,182.57
| Facility | | $3,162.28 | $6,309.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $4,265.80
| Facility | | $2,137.96 | $2,818.38 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $8,128.31
| Facility | | $933.25 | $1,412.54 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,025.60 / $12,302.69
| Facility | | $2,754.23 | $6,025.60 | $12,302.69 |