- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.16 / $7,119.04 / $20,928.72
| Facility | | $1,315.16 | $7,119.04 | $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
- $1,315.16 / $2,367.29 / $9,815.00
| Facility | | $1,315.16 | $2,367.29 | $9,815.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.68 / $3,305.20 / $4,545.04
| Facility | | $1,704.68 | $3,305.20 | $4,545.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |