- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.40 / $10,296.48 / $19,916.72
| Facility | | $7,828.40 | $10,296.48 | $19,916.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,286.02 / $14,286.02 / $14,286.02
| Facility | | $14,286.02 | $14,286.02 | $14,286.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.42 / $692.61 / $9,696.00
| Facility | | $407.42 | $692.61 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.95 / $1,316.74 / $19,048.02
| Facility | | $767.95 | $1,316.74 | $19,048.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,939.00 / $8,158.00 / $9,496.00
| Facility | | $6,939.00 | $8,158.00 | $9,496.00 |