- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,477.27 / $20,928.72
| Facility | | $4,241.22 | $8,477.27 | $20,928.72 |
- 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
- $982.95 / $1,720.16 / $8,632.00
| Facility | | $982.95 | $1,720.16 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.14 / $2,547.92 / $5,383.60
| Facility | | $1,319.14 | $2,547.92 | $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 |