- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,005.00 / $10,563.53 / $20,928.72
| Facility | | $5,005.00 | $10,563.53 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,281.85 / $5,631.80 / $10,893.72
| Facility | | $4,281.85 | $5,631.80 | $10,893.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.45 / $1,845.47 / $6,269.70
| Facility | | $814.45 | $1,845.47 | $6,269.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.83 / $1,869.47 / $2,426.00
| Facility | | $1,334.83 | $1,869.47 | $2,426.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |