- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- 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
- $659.52 / $1,132.46 / $6,817.20
| Facility | | $659.52 | $1,132.46 | $6,817.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.33 / $1,616.74 / $2,256.42
| Facility | | $1,203.33 | $1,616.74 | $2,256.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,562.76 / $4,236.79 / $7,772.00
| Facility | | $3,562.76 | $4,236.79 | $7,772.00 |