- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,752.78 / $10,431.19 / $20,928.72
| Facility | | $3,752.78 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,094.34 / $5,385.17 / $10,416.66
| Facility | | $4,094.34 | $5,385.17 | $10,416.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.39 / $1,019.50 / $7,441.00
| Facility | | $566.39 | $1,019.50 | $7,441.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,139.00 / $1,528.90 / $2,961.89
| Facility | | $1,139.00 | $1,528.90 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $6,178.00 / $8,632.00
| Facility | | $4,700.00 | $6,178.00 | $8,632.00 |