- 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
- $4,998.88 / $6,774.77 / $12,717.97
| Facility | | $4,998.88 | $6,774.77 | $12,717.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.87 / $666.44 / $7,772.00
| Facility | | $377.87 | $666.44 | $7,772.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.62 / $945.75 / $3,145.09
| Facility | | $710.62 | $945.75 | $3,145.09 |
- 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 |