- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,722.42 / $10,492.00 / $15,171.00
| Facility | | $4,722.42 | $10,492.00 | $15,171.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,526.90 / $11,769.08 / $15,551.00
| Facility | | $7,526.90 | $11,769.08 | $15,551.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.00 / $12,228.13 / $15,224.00
| Facility | | $998.00 | $12,228.13 | $15,224.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,608.60 / $3,091.56 / $3,254.67
| Facility | | $1,608.60 | $3,091.56 | $3,254.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,354.00 / $10,336.00 / $18,238.00
| Facility | | $1,354.00 | $10,336.00 | $18,238.00 |