- 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
- $15,547.24 / $20,448.87 / $39,554.72
| Facility | | $15,547.24 | $20,448.87 | $39,554.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.14 / $539.72 / $8,220.00
| Facility | | $353.14 | $539.72 | $8,220.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.03 / $677.96 / $793.61
| Facility | | $555.03 | $677.96 | $793.61 |
- 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 |