- 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
- $9,732.29 / $13,189.77 / $24,760.56
| Facility | | $9,732.29 | $13,189.77 | $24,760.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.94 / $806.51 / $7,934.00
| Facility | | $450.94 | $806.51 | $7,934.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.60 / $1,141.99 / $4,791.04
| Facility | | $855.60 | $1,141.99 | $4,791.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,963.43 / $5,356.00 / $7,934.00
| Facility | | $3,963.43 | $5,356.00 | $7,934.00 |