- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,966.66 / $8,409.00 / $20,928.72
| Facility | | $2,966.66 | $8,409.00 | $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
- $548.97 / $988.15 / $4,803.10
| Facility | | $548.97 | $988.15 | $4,803.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.27 / $1,478.94 / $2,961.89
| Facility | | $896.27 | $1,478.94 | $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 |