- 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
- $6,416.80 / $9,302.56 / $16,325.39
| Facility | | $6,416.80 | $9,302.56 | $16,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.49 / $1,202.42 / $1,721.79
| Facility | | $711.49 | $1,202.42 | $1,721.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.00 / $1,749.62 / $2,335.06
| Facility | | $1,244.00 | $1,749.62 | $2,335.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |