- 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
- $840.13 / $1,428.22 / $2,713.92
| Facility | | $840.13 | $1,428.22 | $2,713.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,524.00 / $2,093.15 / $2,960.61
| Facility | | $1,524.00 | $2,093.15 | $2,960.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $19,670.00
| Facility | | $5,341.00 | $7,441.00 | $19,670.00 |