- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,947.33 / $21,899.37
| Facility | | $5,463.36 | $10,947.33 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,718.25 / $13,170.73 / $24,724.83
| Facility | | $9,718.25 | $13,170.73 | $24,724.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.36 / $1,325.81 / $15,412.10
| Facility | | $718.36 | $1,325.81 | $15,412.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.03 / $1,805.33 / $8,854.25
| Facility | | $1,351.03 | $1,805.33 | $8,854.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |