- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $9,120.11 / $16,595.87
| Facility | | $2,290.87 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,918.31 / $12,302.69
| Facility | | $2,754.23 | $6,918.31 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $3,388.44
| Facility | | $707.95 | $707.95 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,023.29 / $2,089.30
| Facility | | $794.33 | $1,023.29 | $2,089.30 |
- 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 |