- 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
- $776.93 / $1,320.78 / $1,905.99
| Facility | | $776.93 | $1,320.78 | $1,905.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,362.00 / $1,928.66 / $2,565.44
| Facility | | $1,362.00 | $1,928.66 | $2,565.44 |
- 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 |