- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,230.58 / $14,595.34 / $29,068.82
| Facility | | $4,230.58 | $14,595.34 | $29,068.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,952.92 / $8,688.18 / $14,940.72
| Facility | | $3,952.92 | $8,688.18 | $14,940.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,639.40 / $3,639.40 / $4,676.68
| Facility | | $3,639.40 | $3,639.40 | $4,676.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.00 / $1,210.55 / $1,953.71
| Facility | | $849.00 | $1,210.55 | $1,953.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |