- 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
- $947.19 / $2,144.06 / $7,934.00
| Facility | | $947.19 | $2,144.06 | $7,934.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.64 / $1,913.58 / $2,807.92
| Facility | | $1,471.64 | $1,913.58 | $2,807.92 |
- 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 |