- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.28 / $8,355.33 / $19,276.96
| Facility | | $3,204.28 | $8,355.33 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,522.03 / $5,947.70 / $11,504.78
| Facility | | $4,522.03 | $5,947.70 | $11,504.78 |
- 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
- $430.00 / $817.00 / $5,405.32
| Facility | | $430.00 | $817.00 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.55 / $1,180.14 / $2,961.89
| Facility | | $865.55 | $1,180.14 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |