- 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
- $9,584.12 / $13,894.28 / $24,383.56
| Facility | | $9,584.12 | $13,894.28 | $24,383.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.20 / $2,092.56 / $3,076.35
| Facility | | $1,238.20 | $2,092.56 | $3,076.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,249.00 / $3,044.36 / $4,230.76
| Facility | | $2,249.00 | $3,044.36 | $4,230.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |