- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.29 / $5,463.36 / $13,841.56
| Facility | | $2,166.29 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,165.50 / $10,739.86 / $20,774.36
| Facility | | $8,165.50 | $10,739.86 | $20,774.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.93 / $597.90 / $8,816.00
| Facility | | $381.93 | $597.90 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.36 / $879.59 / $3,733.42
| Facility | | $597.36 | $879.59 | $3,733.42 |
- 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 |