- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $16,218.10 / $25,118.86
| Facility | | $1,513.56 | $16,218.10 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $18,620.87 / $26,302.68
| Facility | | $7,413.10 | $18,620.87 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,318.26 / $1,479.11
| Facility | | $1,258.93 | $1,318.26 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,089.30 / $2,691.53
| Facility | | $1,318.26 | $2,089.30 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,549.93 / $16,218.10
| Facility | | $4,466.84 | $9,549.93 | $16,218.10 |