- 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
- $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
- $875.96 / $1,556.96 / $7,300.58
| Facility | | $875.96 | $1,556.96 | $7,300.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,536.00 / $2,000.50 / $2,747.85
| Facility | | $1,536.00 | $2,000.50 | $2,747.85 |
- 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 |