- 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
- $14,535.24 / $21,072.03 / $36,980.03
| Facility | | $14,535.24 | $21,072.03 | $36,980.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.60 / $1,255.61 / $1,933.59
| Facility | | $738.60 | $1,255.61 | $1,933.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.00 / $1,861.70 / $2,460.40
| Facility | | $1,310.00 | $1,861.70 | $2,460.40 |
- 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 |