- 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
- $1,311.17 / $1,724.55 / $3,335.83
| Facility | | $1,311.17 | $1,724.55 | $3,335.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.14 / $1,071.66 / $8,816.00
| Facility | | $719.14 | $1,071.66 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.99 / $1,685.58 / $3,972.29
| Facility | | $1,122.99 | $1,685.58 | $3,972.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |