- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,217.00 / $20,928.72
| Facility | | $4,241.22 | $8,217.00 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,118.27 / $6,731.93 / $13,021.72
| Facility | | $5,118.27 | $6,731.93 | $13,021.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.02 / $1,257.76 / $9,696.00
| Facility | | $844.02 | $1,257.76 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.18 / $1,635.64 / $2,224.98
| Facility | | $1,316.18 | $1,635.64 | $2,224.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |