- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,489.78 / $7,958.64 / $13,966.90
| Facility | | $5,489.78 | $7,958.64 | $13,966.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,364.51 / $2,319.67 / $3,549.06
| Facility | | $1,364.51 | $2,319.67 | $3,549.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,478.00 / $3,296.18 / $4,659.39
| Facility | | $2,478.00 | $3,296.18 | $4,659.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |