- 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
- $8,362.84 / $10,999.42 / $21,276.43
| Facility | | $8,362.84 | $10,999.42 | $21,276.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,769.97 / $12,769.97 / $12,769.97
| Facility | | $12,769.97 | $12,769.97 | $12,769.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.17 / $1,019.75 / $9,696.00
| Facility | | $565.17 | $1,019.75 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.78 / $1,531.39 / $16,175.29
| Facility | | $1,148.78 | $1,531.39 | $16,175.29 |
- 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 |