- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,355.33 / $19,276.96
| Facility | | $4,083.97 | $8,355.33 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,099.31 / $6,706.99 / $12,973.48
| Facility | | $5,099.31 | $6,706.99 | $12,973.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.66 / $1,230.77 / $4,236.79
| Facility | | $621.66 | $1,230.77 | $4,236.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.03 / $1,608.77 / $2,283.61
| Facility | | $1,115.03 | $1,608.77 | $2,283.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,231.39 / $5,356.00 / $7,934.00
| Facility | | $2,231.39 | $5,356.00 | $7,934.00 |