- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,301.06 / $7,119.04 / $19,276.96
| Facility | | $3,301.06 | $7,119.04 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,949.61 / $3,879.54 / $7,504.28
| Facility | | $2,949.61 | $3,879.54 | $7,504.28 |
- 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
- $535.78 / $964.40 / $4,038.98
| Facility | | $535.78 | $964.40 | $4,038.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.00 / $1,325.24 / $2,961.89
| Facility | | $967.00 | $1,325.24 | $2,961.89 |
- 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 |