- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,265.80 / $12,882.50
| Facility | | $1,778.28 | $4,265.80 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $21,877.62
| Facility | | $2,238.72 | $4,897.79 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,413.10 / $11,220.18
| Facility | | $4,466.84 | $7,413.10 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,235.94 / $32,359.37
| Facility | | $616.60 | $3,235.94 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,786.30 / $18,197.01
| Facility | | $3,162.28 | $4,786.30 | $18,197.01 |