- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,426.85 / $8,909.33 / $20,928.72
| Facility | | $3,426.85 | $8,909.33 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- 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
- $441.01 / $793.82 / $5,405.32
| Facility | | $441.01 | $793.82 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.00 / $1,298.27 / $2,961.89
| Facility | | $857.00 | $1,298.27 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |