- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,365.16 / $5,495.41
| Facility | | $1,862.09 | $4,365.16 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,918.31 / $18,620.87
| Facility | | $2,511.89 | $6,918.31 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,623.41
| Facility | | $5,495.41 | $5,495.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,148.15 / $1,862.09
| Facility | | $724.44 | $1,148.15 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,218.10 / $22,908.68
| Facility | | $12,022.64 | $16,218.10 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $10,232.93 / $27,542.29
| Facility | | $2,089.30 | $10,232.93 | $27,542.29 |