- 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
- $853.99 / $1,494.48 / $6,161.54
| Facility | | $853.99 | $1,494.48 | $6,161.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.44 / $2,133.67 / $2,914.71
| Facility | | $1,092.44 | $2,133.67 | $2,914.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |