- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,355.33 / $19,276.96
| Facility | | $4,083.97 | $8,355.33 | $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
- $622.52 / $1,089.41 / $4,803.10
| Facility | | $622.52 | $1,089.41 | $4,803.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,543.50 / $2,961.89
| Facility | | $1,089.00 | $1,543.50 | $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 |