- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $9,549.93 / $16,595.87
| Facility | | $2,630.27 | $9,549.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,413.10 / $14,125.38
| Facility | | $3,235.94 | $7,413.10 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $2,818.38
| Facility | | $812.83 | $812.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $1,737.80
| Facility | | $691.83 | $1,023.29 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $13,182.57 / $23,988.33
| Facility | | $5,128.61 | $13,182.57 | $23,988.33 |