- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,897.79 / $16,218.10
| Facility | | $1,023.29 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $18,197.01 / $26,302.68
| Facility | | $7,413.10 | $18,197.01 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,258.93 / $2,041.74
| Facility | | $812.83 | $1,258.93 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $9,549.93 / $16,218.10
| Facility | | $3,801.89 | $9,549.93 | $16,218.10 |