- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $9,544.15 / $20,928.72
| Facility | | $5,463.36 | $9,544.15 | $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
- $512.66 / $871.54 / $1,195.33
| Facility | | $512.66 | $871.54 | $1,195.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.42 / $1,285.00 / $2,516.35
| Facility | | $863.42 | $1,285.00 | $2,516.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,138.10 / $6,178.00 / $8,816.00
| Facility | | $2,138.10 | $6,178.00 | $8,816.00 |