- 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
- $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
- $484.38 / $823.45 / $1,340.00
| Facility | | $484.38 | $823.45 | $1,340.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.03 / $1,285.00 / $2,516.35
| Facility | | $849.03 | $1,285.00 | $2,516.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,413.81 / $4,217.00 / $7,772.00
| Facility | | $3,413.81 | $4,217.00 | $7,772.00 |