- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,897.79 / $16,595.87
| Facility | | $1,778.28 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,918.31 / $12,882.50
| Facility | | $2,884.03 | $6,918.31 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $891.25 / $1,479.11
| Facility | | $630.96 | $891.25 | $1,479.11 |
- 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 |