- 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
- $7,184.40 / $10,415.37 / $18,278.29
| Facility | | $7,184.40 | $10,415.37 | $18,278.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.16 / $1,505.10 / $2,219.13
| Facility | | $792.16 | $1,505.10 | $2,219.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,546.75 / $2,305.54 / $5,251.23
| Facility | | $1,546.75 | $2,305.54 | $5,251.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |