- 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
- $955.63 / $1,615.01 / $2,307.57
| Facility | | $955.63 | $1,615.01 | $2,307.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $2,291.83 / $3,194.23
| Facility | | $1,682.00 | $2,291.83 | $3,194.23 |
- 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 |