- 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
- $8,383.91 / $11,027.13 / $21,330.03
| Facility | | $8,383.91 | $11,027.13 | $21,330.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.60 / $2,357.54 / $13,909.00
| Facility | | $1,533.60 | $2,357.54 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,408.59 / $3,003.62 / $4,038.36
| Facility | | $2,408.59 | $3,003.62 | $4,038.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |