- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $8,709.64 / $16,595.87
| Facility | | $2,754.23 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,332.54 / $16,982.44
| Facility | | $4,466.84 | $9,332.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,288.25 / $1,778.28
| Facility | | $977.24 | $1,288.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,378.01 / $25,703.96
| Facility | | $2,884.03 | $17,378.01 | $25,703.96 |