- 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
- $5,121.08 / $6,940.38 / $13,028.86
| Facility | | $5,121.08 | $6,940.38 | $13,028.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.64 / $1,678.82 / $7,772.00
| Facility | | $935.64 | $1,678.82 | $7,772.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.00 / $2,176.17 / $2,788.90
| Facility | | $1,463.00 | $2,176.17 | $2,788.90 |
- 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 |