- 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
- $6,992.68 / $9,476.87 / $17,790.50
| Facility | | $6,992.68 | $9,476.87 | $17,790.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,616.19 / $2,633.21 / $7,856.00
| Facility | | $1,616.19 | $2,633.21 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.00 / $3,610.60 / $5,093.21
| Facility | | $2,647.00 | $3,610.60 | $5,093.21 |
- 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 |