- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.63 / $3,041.74 / $5,883.72
| Facility | | $2,312.63 | $3,041.74 | $5,883.72 |
- 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
- $402.70 / $704.73 / $3,044.00
| Facility | | $402.70 | $704.73 | $3,044.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.00 / $1,086.11 / $1,597.11
| Facility | | $721.00 | $1,086.11 | $1,597.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |