- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,248.07 / $20,892.96
| Facility | | $2,818.38 | $5,248.07 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,995.26 / $2,290.87
| Facility | | $707.95 | $1,995.26 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $5,011.87
| Facility | | $1,995.26 | $2,951.21 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,981.07 / $4,265.80
| Facility | | $3,235.94 | $3,981.07 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,951.21
| Facility | | $2,818.38 | $2,818.38 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,318.26 / $5,754.40
| Facility | | $707.95 | $1,318.26 | $5,754.40 |