- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.50 / $10,506.16 / $21,899.37
| Facility | | $4,570.50 | $10,506.16 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,007.90 / $3,924.55 / $7,652.58
| Facility | | $3,007.90 | $3,924.55 | $7,652.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.47 / $1,821.47 / $1,821.47
| Facility | | $1,821.47 | $1,821.47 | $1,821.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.19 / $1,545.69 / $6,887.55
| Facility | | $731.19 | $1,545.69 | $6,887.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.09 / $1,823.69 / $2,373.75
| Facility | | $1,269.09 | $1,823.69 | $2,373.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,839.11 / $3,093.00 / $7,772.00
| Facility | | $2,839.11 | $3,093.00 | $7,772.00 |