- 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
- $5,489.78 / $7,958.64 / $13,966.90
| Facility | | $5,489.78 | $7,958.64 | $13,966.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.80 / $1,716.66 / $2,628.14
| Facility | | $1,009.80 | $1,716.66 | $2,628.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $2,428.65 / $3,351.28
| Facility | | $1,749.00 | $2,428.65 | $3,351.28 |
- 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 |