- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,616.09 / $8,477.27 / $20,928.72
| Facility | | $1,616.09 | $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
- $1,616.09 / $2,908.96 / $9,815.00
| Facility | | $1,616.09 | $2,908.96 | $9,815.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,110.03 / $4,097.85 / $5,805.47
| Facility | | $2,110.03 | $4,097.85 | $5,805.47 |
- 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 |