- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,876.70 / $8,477.27 / $19,276.96
| Facility | | $3,876.70 | $8,477.27 | $19,276.96 |
- 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
- $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
- $708.23 / $1,239.40 / $5,405.32
| Facility | | $708.23 | $1,239.40 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,755.57 / $2,961.89
| Facility | | $1,089.00 | $1,755.57 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $6,325.00 / $8,816.00
| Facility | | $4,700.00 | $6,325.00 | $8,816.00 |