- 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
- $8,501.19 / $11,521.30 / $21,628.42
| Facility | | $8,501.19 | $11,521.30 | $21,628.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.56 / $1,474.64 / $7,856.00
| Facility | | $981.56 | $1,474.64 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $2,154.50 / $2,935.11
| Facility | | $1,697.00 | $2,154.50 | $2,935.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.00 / $4,317.00 / $7,856.00
| Facility | | $3,126.00 | $4,317.00 | $7,856.00 |