- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,252.23 / $9,185.68 / $20,928.72
| Facility | | $2,252.23 | $9,185.68 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,118.27 / $6,731.93 / $13,021.72
| Facility | | $5,118.27 | $6,731.93 | $13,021.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.76 / $1,586.82 / $8,632.00
| Facility | | $880.76 | $1,586.82 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,847.68 / $3,018.60
| Facility | | $1,285.00 | $1,847.68 | $3,018.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $6,178.00 / $8,632.00
| Facility | | $4,700.00 | $6,178.00 | $8,632.00 |