- 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
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.80 / $1,217.65 / $4,217.00
| Facility | | $695.80 | $1,217.65 | $4,217.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,597.29 / $2,253.46
| Facility | | $1,257.44 | $1,597.29 | $2,253.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |