- 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 / $8,696.41 / $16,325.39
| Facility | | $6,416.80 | $8,696.41 | $16,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.45 / $1,370.88 / $6,587.28
| Facility | | $790.45 | $1,370.88 | $6,587.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.00 / $1,772.70 / $2,467.34
| Facility | | $1,368.00 | $1,772.70 | $2,467.34 |
- 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 |