- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,015.13 / $8,477.27 / $19,276.96
| Facility | | $3,015.13 | $8,477.27 | $19,276.96 |
- 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
- $488.09 / $902.97 / $5,693.90
| Facility | | $488.09 | $902.97 | $5,693.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.84 / $1,317.14 / $2,961.89
| Facility | | $949.84 | $1,317.14 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |