- 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
- $5,578.27 / $7,559.99 / $14,192.03
| Facility | | $5,578.27 | $7,559.99 | $14,192.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.52 / $532.13 / $4,017.35
| Facility | | $299.52 | $532.13 | $4,017.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.83 / $755.28 / $1,331.66
| Facility | | $566.83 | $755.28 | $1,331.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.91 / $2,753.18 / $7,772.00
| Facility | | $2,016.91 | $2,753.18 | $7,772.00 |