- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,918.31 / $18,620.87
| Facility | | $3,162.28 | $6,918.31 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $14,125.38 / $26,302.68
| Facility | | $7,413.10 | $14,125.38 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $4,786.30
| Facility | | $1,000.00 | $2,951.21 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $6,165.95
| Facility | | $5,888.44 | $5,888.44 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $11,220.18 / $21,379.62
| Facility | | $1,659.59 | $11,220.18 | $21,379.62 |