- 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
- $11,018.89 / $14,492.85 / $28,033.86
| Facility | | $11,018.89 | $14,492.85 | $28,033.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,309.49 / $2,037.56 / $9,696.00
| Facility | | $1,309.49 | $2,037.56 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,057.17 / $2,545.83 / $3,464.98
| Facility | | $2,057.17 | $2,545.83 | $3,464.98 |
- 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 |