- 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
- $7,838.93 / $11,364.26 / $19,943.52
| Facility | | $7,838.93 | $11,364.26 | $19,943.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.19 / $904.72 / $1,403.67
| Facility | | $532.19 | $904.72 | $1,403.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.11 / $1,335.83 / $3,033.31
| Facility | | $993.11 | $1,335.83 | $3,033.31 |
- 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 |