- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,752.78 / $7,120.36 / $20,928.72
| Facility | | $3,752.78 | $7,120.36 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,306.43 / $5,664.13 / $10,956.25
| Facility | | $4,306.43 | $5,664.13 | $10,956.25 |
- 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
- $770.66 / $1,348.66 / $5,405.32
| Facility | | $770.66 | $1,348.66 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,933.57 / $2,961.89
| Facility | | $1,285.00 | $1,933.57 | $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 |