- 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
- $7,970.26 / $11,554.64 / $20,277.64
| Facility | | $7,970.26 | $11,554.64 | $20,277.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.84 / $2,174.98 / $3,740.93
| Facility | | $1,242.84 | $2,174.98 | $3,740.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,328.00 / $2,962.13 / $4,161.93
| Facility | | $2,328.00 | $2,962.13 | $4,161.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |