- 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
- $686.12 / $1,166.40 / $1,693.30
| Facility | | $686.12 | $1,166.40 | $1,693.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,155.58 / $1,710.52 / $2,516.35
| Facility | | $1,155.58 | $1,710.52 | $2,516.35 |
- 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 |