- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,172.55 / $8,477.27 / $19,276.96
| Facility | | $3,172.55 | $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
- $403.94 / $747.76 / $5,405.32
| Facility | | $403.94 | $747.76 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.67 / $1,187.78 / $2,961.89
| Facility | | $816.67 | $1,187.78 | $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 |