- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- 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
- $6,982.41 / $6,982.41 / $6,982.41
| Facility | | $6,982.41 | $6,982.41 | $6,982.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.10 / $1,338.29 / $9,496.00
| Facility | | $725.10 | $1,338.29 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,951.85 / $8,738.77
| Facility | | $1,285.00 | $1,951.85 | $8,738.77 |
- 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 |