- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $9,120.11 / $16,595.87
| Facility | | $2,511.89 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,265.80 / $7,943.28
| Facility | | $2,041.74 | $4,265.80 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $2,570.40
| Facility | | $575.44 | $575.44 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,148.15 / $1,995.26
| Facility | | $891.25 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $13,182.57 / $23,988.33
| Facility | | $2,137.96 | $13,182.57 | $23,988.33 |