- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,606.93 / $19,952.62
| Facility | | $2,511.89 | $6,606.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,882.50 / $19,952.62
| Facility | | $8,912.51 | $12,882.50 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $16,982.44 / $27,542.29
| Facility | | $3,715.35 | $16,982.44 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,884.03 / $19,498.45
| Facility | | $707.95 | $2,884.03 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,630.78 / $20,417.38
| Facility | | $2,884.03 | $3,630.78 | $20,417.38 |