- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,760.20 / $7,120.36 / $20,928.72
| Facility | | $2,760.20 | $7,120.36 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,489.78 / $7,958.64 / $13,966.90
| Facility | | $5,489.78 | $7,958.64 | $13,966.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.68 / $750.86 / $3,154.56
| Facility | | $441.68 | $750.86 | $3,154.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.31 / $1,183.50 / $2,516.35
| Facility | | $729.31 | $1,183.50 | $2,516.35 |
- 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 |