- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.61 / $8,477.27 / $20,928.72
| Facility | | $1,301.61 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.40 / $10,296.48 / $19,916.72
| Facility | | $7,828.40 | $10,296.48 | $19,916.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.61 / $2,277.84 / $4,406.00
| Facility | | $1,301.61 | $2,277.84 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.78 / $3,294.74 / $4,587.43
| Facility | | $1,704.78 | $3,294.74 | $4,587.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |