- 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
- $3,896.29 / $5,280.48 / $9,912.79
| Facility | | $3,896.29 | $5,280.48 | $9,912.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.15 / $864.90 / $5,444.45
| Facility | | $486.15 | $864.90 | $5,444.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.97 / $1,224.54 / $1,813.25
| Facility | | $916.97 | $1,224.54 | $1,813.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |