- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,477.27 / $19,276.96
| Facility | | $4,083.97 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,678.11 / $12,678.11 / $12,678.11
| Facility | | $12,678.11 | $12,678.11 | $12,678.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.12 / $1,480.71 / $9,696.00
| Facility | | $846.12 | $1,480.71 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $2,104.55 / $16,713.82
| Facility | | $1,089.00 | $2,104.55 | $16,713.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |