- 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
- $5,578.27 / $7,559.99 / $14,192.03
| Facility | | $5,578.27 | $7,559.99 | $14,192.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.73 / $1,070.08 / $4,317.00
| Facility | | $630.73 | $1,070.08 | $4,317.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.00 / $1,403.19 / $1,961.73
| Facility | | $1,102.00 | $1,403.19 | $1,961.73 |
- 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 |