- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,495.41 / $12,022.64
| Facility | | $1,621.81 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,456.54 / $18,620.87
| Facility | | $2,290.87 | $6,456.54 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,265.80
| Facility | | $4,168.69 | $4,168.69 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,174.90 / $2,089.30
| Facility | | $691.83 | $1,174.90 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,218.10 / $22,908.68
| Facility | | $12,022.64 | $16,218.10 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $9,332.54 / $18,197.01
| Facility | | $1,513.56 | $9,332.54 | $18,197.01 |