- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,005.00 / $10,431.19 / $20,928.72
| Facility | | $5,005.00 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,833.84 / $6,306.95 / $12,298.09
| Facility | | $4,833.84 | $6,306.95 | $12,298.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.56 / $2,380.56 / $2,380.56
| Facility | | $2,380.56 | $2,380.56 | $2,380.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.40 / $1,789.07 / $8,816.00
| Facility | | $898.40 | $1,789.07 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,364.39 / $3,015.38
| Facility | | $1,285.00 | $2,364.39 | $3,015.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |