- 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
- $21,141.54 / $21,141.54 / $21,141.54
| Facility | | $21,141.54 | $21,141.54 | $21,141.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.39 / $1,960.68 / $9,696.00
| Facility | | $1,120.39 | $1,960.68 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.01 / $2,982.71 / $26,120.86
| Facility | | $1,470.01 | $2,982.71 | $26,120.86 |
- 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 |