- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $22,718.07
| Facility | | $4,241.22 | $10,431.19 | $22,718.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,283.48 / $11,226.25 / $21,074.53
| Facility | | $8,283.48 | $11,226.25 | $21,074.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.73 / $1,497.52 / $6,993.42
| Facility | | $840.73 | $1,497.52 | $6,993.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.00 / $1,874.07 / $2,630.79
| Facility | | $1,471.00 | $1,874.07 | $2,630.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |