- 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
- $5,099.31 / $6,706.99 / $12,973.48
| Facility | | $5,099.31 | $6,706.99 | $12,973.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.50 / $1,969.70 / $8,816.00
| Facility | | $930.50 | $1,969.70 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,435.95 / $2,327.53 / $3,908.14
| Facility | | $1,435.95 | $2,327.53 | $3,908.14 |
- 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 |