- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,506.16 / $21,899.37
| Facility | | $5,463.36 | $10,506.16 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,093.16 / $10,968.31 / $20,590.32
| Facility | | $8,093.16 | $10,968.31 | $20,590.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.30 / $1,562.16 / $8,632.00
| Facility | | $876.30 | $1,562.16 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.00 / $2,004.24 / $2,783.32
| Facility | | $1,517.00 | $2,004.24 | $2,783.32 |
- 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 |