- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,917.20 / $9,608.62 / $19,276.96
| Facility | | $4,917.20 | $9,608.62 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,725.11 / $8,845.35 / $17,109.75
| Facility | | $6,725.11 | $8,845.35 | $17,109.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.33 / $774.28 / $8,816.00
| Facility | | $515.33 | $774.28 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.82 / $1,089.00 / $3,018.60
| Facility | | $804.82 | $1,089.00 | $3,018.60 |
- 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 |