- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $9,120.11 / $21,877.62
| Facility | | $1,096.48 | $9,120.11 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,120.11 / $16,595.87
| Facility | | $3,715.35 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $4,897.79
| Facility | | $3,801.89 | $3,801.89 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $1,905.46
| Facility | | $741.31 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $20,417.38 / $25,703.96
| Facility | | $8,709.64 | $20,417.38 | $25,703.96 |