- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,230.00 / $8,477.27 / $19,276.96
| Facility | | $3,230.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,306.43 / $5,664.13 / $10,956.25
| Facility | | $4,306.43 | $5,664.13 | $10,956.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.14 / $1,610.25 / $5,405.32
| Facility | | $920.14 | $1,610.25 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,107.06 / $2,285.21 / $3,111.82
| Facility | | $1,107.06 | $2,285.21 | $3,111.82 |
- 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 |