- 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
- $5,118.27 / $6,731.93 / $13,021.72
| Facility | | $5,118.27 | $6,731.93 | $13,021.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.83 / $1,236.58 / $6,169.00
| Facility | | $650.83 | $1,236.58 | $6,169.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.00 / $1,582.97 / $2,130.02
| Facility | | $1,202.00 | $1,582.97 | $2,130.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |