- 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
- $3,551.47 / $5,148.63 / $9,035.51
| Facility | | $3,551.47 | $5,148.63 | $9,035.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.88 / $662.80 / $1,241.22
| Facility | | $389.88 | $662.80 | $1,241.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.00 / $926.48 / $1,296.26
| Facility | | $706.00 | $926.48 | $1,296.26 |
- 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 |