- 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
- $4,609.82 / $6,247.48 / $11,728.12
| Facility | | $4,609.82 | $6,247.48 | $11,728.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.61 / $934.06 / $6,817.20
| Facility | | $546.61 | $934.06 | $6,817.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.88 / $1,275.96 / $2,256.42
| Facility | | $852.88 | $1,275.96 | $2,256.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |