- 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
- $6,916.13 / $9,096.60 / $17,595.75
| Facility | | $6,916.13 | $9,096.60 | $17,595.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.46 / $1,923.72 / $9,696.00
| Facility | | $1,250.46 | $1,923.72 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,964.09 / $2,440.81 / $3,300.29
| Facility | | $1,964.09 | $2,440.81 | $3,300.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,214.54 / $8,163.00 / $9,696.00
| Facility | | $4,214.54 | $8,163.00 | $9,696.00 |