- 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
- $6,416.80 / $9,302.56 / $16,325.39
| Facility | | $6,416.80 | $9,302.56 | $16,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.25 / $1,920.26 / $2,770.56
| Facility | | $1,136.25 | $1,920.26 | $2,770.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,952.00 / $2,831.13 / $3,757.80
| Facility | | $1,952.00 | $2,831.13 | $3,757.80 |
- 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 |