- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $5,463.36 / $13,841.56
| Facility | | $2,318.31 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,906.94 / $8,005.42 / $15,028.22
| Facility | | $5,906.94 | $8,005.42 | $15,028.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.28 / $654.23 / $18,460.24
| Facility | | $393.28 | $654.23 | $18,460.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.05 / $888.64 / $21,010.16
| Facility | | $696.05 | $888.64 | $21,010.16 |
- 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 |