- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,943.28 / $11,748.98
| Facility | | $2,454.71 | $7,943.28 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,623.41 / $11,481.54
| Facility | | $2,951.21 | $5,623.41 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,995.26
| Facility | | $501.19 | $501.19 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,122.02 / $2,187.76
| Facility | | $870.96 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $12,882.50 / $23,442.29
| Facility | | $2,137.96 | $12,882.50 | $23,442.29 |