- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,754.40 / $13,489.63
| Facility | | $2,511.89 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $8,709.64 / $15,848.93
| Facility | | $2,511.89 | $8,709.64 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $11,481.54 / $19,952.62
| Facility | | $8,128.31 | $11,481.54 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,162.28 / $13,489.63
| Facility | | $707.95 | $3,162.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $12,882.50
| Facility | | $2,884.03 | $5,128.61 | $12,882.50 |