- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,005.00 / $10,563.53 / $20,928.72
| Facility | | $5,005.00 | $10,563.53 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,889.38 / $7,684.16 / $14,983.55
| Facility | | $5,889.38 | $7,684.16 | $14,983.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,970.81 / $4,970.81 / $4,970.81
| Facility | | $4,970.81 | $4,970.81 | $4,970.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.34 / $2,280.48 / $8,816.00
| Facility | | $1,007.34 | $2,280.48 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,717.12 / $2,853.55 / $6,358.91
| Facility | | $1,717.12 | $2,853.55 | $6,358.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |