- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $11,100.08 / $24,068.03
| Facility | | $4,241.22 | $11,100.08 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,086.90 / $11,951.75 / $23,118.55
| Facility | | $9,086.90 | $11,951.75 | $23,118.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,376.03 / $4,376.03 / $4,376.03
| Facility | | $4,376.03 | $4,376.03 | $4,376.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.83 / $1,205.45 / $8,632.00
| Facility | | $688.83 | $1,205.45 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,378.80 / $1,932.00 / $5,383.60
| Facility | | $1,378.80 | $1,932.00 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |