- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.64 / $4,828.00 / $4,931.85
| Facility | | $373.64 | $4,828.00 | $4,931.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,869.64 / $10,083.07 / $20,316.56
| Facility | | $3,869.64 | $10,083.07 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,620.95 / $15,061.83 / $36,233.26
| Facility | | $10,620.95 | $15,061.83 | $36,233.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,362.95 / $13,770.12 / $28,530.13
| Facility | | $8,362.95 | $13,770.12 | $28,530.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.00 / $4,905.55 / $12,051.00
| Facility | | $592.00 | $4,905.55 | $12,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |