- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,862.68 / $9,140.95 / $20,928.72
| Facility | | $4,862.68 | $9,140.95 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,912.62 / $9,368.37 / $17,586.82
| Facility | | $6,912.62 | $9,368.37 | $17,586.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.72 / $1,526.16 / $9,696.00
| Facility | | $818.72 | $1,526.16 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.98 / $1,851.53 / $5,275.65
| Facility | | $1,367.98 | $1,851.53 | $5,275.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |