- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $11,923.23 / $24,068.03
| Facility | | $4,241.22 | $11,923.23 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.60 / $13,313.50 / $24,992.84
| Facility | | $9,823.60 | $13,313.50 | $24,992.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.21 / $6,039.56 / $9,852.01
| Facility | | $537.21 | $6,039.56 | $9,852.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.94 / $8,499.94 / $12,593.32
| Facility | | $1,092.94 | $8,499.94 | $12,593.32 |
- 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 |