- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,719.00 / $20,928.72
| Facility | | $5,463.36 | $10,719.00 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,064.08 / $4,030.10 / $7,795.52
| Facility | | $3,064.08 | $4,030.10 | $7,795.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.34 / $348.40 / $4,406.00
| Facility | | $246.34 | $348.40 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.91 / $475.85 / $658.04
| Facility | | $382.91 | $475.85 | $658.04 |
- 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 |