- 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
- $1,317.28 / $2,226.19 / $3,193.02
| Facility | | $1,317.28 | $2,226.19 | $3,193.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,322.00 / $3,169.55 / $4,466.80
| Facility | | $2,322.00 | $3,169.55 | $4,466.80 |
- 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 |