- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.50 / $9,622.00 / $18,276.00
| Facility | | $1,342.50 | $9,622.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,752.10 / $29,365.77 / $49,542.56
| Facility | | $12,752.10 | $29,365.77 | $49,542.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $1,130.00 / $23,915.85
| Facility | | $890.00 | $1,130.00 | $23,915.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.72 / $1,624.00 / $2,579.78
| Facility | | $1,293.72 | $1,624.00 | $2,579.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $19,915.00 / $30,476.00
| Facility | | $3,340.00 | $19,915.00 | $30,476.00 |