- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,219.04 / $16,264.47 / $28,543.08
| Facility | | $11,219.04 | $16,264.47 | $28,543.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.98 / $1,694.87 / $3,219.70
| Facility | | $996.98 | $1,694.87 | $3,219.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $2,479.61 / $3,414.87
| Facility | | $1,770.00 | $2,479.61 | $3,414.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $19,670.00
| Facility | | $6,777.00 | $8,220.00 | $19,670.00 |