- 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
- $836.21 / $1,421.56 / $2,203.87
| Facility | | $836.21 | $1,421.56 | $2,203.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.00 / $2,080.26 / $2,764.73
| Facility | | $1,316.00 | $2,080.26 | $2,764.73 |
- 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 |