- 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
- $5,503.12 / $7,458.15 / $14,000.85
| Facility | | $5,503.12 | $7,458.15 | $14,000.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.57 / $1,948.03 / $7,856.00
| Facility | | $1,200.57 | $1,948.03 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.00 / $2,766.50 / $3,726.04
| Facility | | $2,163.00 | $2,766.50 | $3,726.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |