- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.81 / $2,318.00 / $7,212.00
| Facility | | $1,053.81 | $2,318.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $6,340.00 / $37,919.46
| Facility | | $2,575.00 | $6,340.00 | $37,919.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.88 / $1,445.14 / $2,167.71
| Facility | | $1,052.88 | $1,445.14 | $2,167.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,558.85 / $11,558.85 / $13,701.88
| Facility | | $11,558.85 | $11,558.85 | $13,701.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,348.00 / $12,569.00
| Facility | | $3,932.00 | $8,348.00 | $12,569.00 |