- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,495.41 / $8,709.64
| Facility | | $2,884.03 | $5,495.41 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,317.64 / $18,620.87
| Facility | | $3,630.78 | $8,317.64 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,265.80
| Facility | | $4,168.69 | $4,168.69 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,230.27 / $3,467.37
| Facility | | $724.44 | $1,230.27 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,218.10 / $22,908.68
| Facility | | $12,022.64 | $16,218.10 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $10,232.93 / $27,542.29
| Facility | | $2,089.30 | $10,232.93 | $27,542.29 |