- 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
- $8,093.16 / $10,968.31 / $20,590.32
| Facility | | $8,093.16 | $10,968.31 | $20,590.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $971.51 / $1,727.39 / $8,122.80
| Facility | | $971.51 | $1,727.39 | $8,122.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $2,209.65 / $3,072.20
| Facility | | $1,682.00 | $2,209.65 | $3,072.20 |
- 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 |