- 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
- $11,219.04 / $16,264.47 / $28,543.08
| Facility | | $11,219.04 | $16,264.47 | $28,543.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,627.98 / $2,767.57 / $4,703.09
| Facility | | $1,627.98 | $2,767.57 | $4,703.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,975.00 / $4,061.84 / $5,713.67
| Facility | | $2,975.00 | $4,061.84 | $5,713.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |