- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,672.00 / $10,431.19 / $20,928.72
| Facility | | $3,672.00 | $10,431.19 | $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
- $3,072.41 / $3,072.41 / $3,072.41
| Facility | | $3,072.41 | $3,072.41 | $3,072.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.72 / $1,177.26 / $4,803.10
| Facility | | $672.72 | $1,177.26 | $4,803.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.00 / $1,670.86 / $3,297.71
| Facility | | $1,244.00 | $1,670.86 | $3,297.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,529.66 / $3,093.00 / $7,934.00
| Facility | | $2,529.66 | $3,093.00 | $7,934.00 |