- 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
- $5,121.08 / $6,940.38 / $13,028.86
| Facility | | $5,121.08 | $6,940.38 | $13,028.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.43 / $1,434.50 / $7,772.00
| Facility | | $800.43 | $1,434.50 | $7,772.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,435.35 / $1,875.58 / $2,636.20
| Facility | | $1,435.35 | $1,875.58 | $2,636.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |