- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.50 / $8,477.27 / $20,928.72
| Facility | | $1,804.50 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.83 / $15,476.59 / $29,936.73
| Facility | | $11,766.83 | $15,476.59 | $29,936.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.50 / $3,157.88 / $5,116.35
| Facility | | $1,804.50 | $3,157.88 | $5,116.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.48 / $4,550.60 / $6,569.85
| Facility | | $2,343.48 | $4,550.60 | $6,569.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |