- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,506.16 / $21,899.37
| Facility | | $5,463.36 | $10,506.16 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,992.68 / $9,476.87 / $17,790.50
| Facility | | $6,992.68 | $9,476.87 | $17,790.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.14 / $1,387.27 / $6,563.76
| Facility | | $730.14 | $1,387.27 | $6,563.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.00 / $1,762.00 / $2,489.25
| Facility | | $1,293.00 | $1,762.00 | $2,489.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,749.50 / $5,341.00 / $8,816.00
| Facility | | $2,749.50 | $5,341.00 | $8,816.00 |