- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $13,803.84 / $23,442.29
| Facility | | $1,445.44 | $13,803.84 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,964.78 / $19,054.61
| Facility | | $4,897.79 | $10,964.78 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,445.44 / $2,344.23
| Facility | | $977.24 | $1,445.44 | $2,344.23 |
- 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 |