- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,279.63 / $6,917.05 / $18,276.00
| Facility | | $1,279.63 | $6,917.05 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,531.58 / $10,107.27 / $19,275.59
| Facility | | $4,531.58 | $10,107.27 | $19,275.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,901.90 / $8,901.90 / $11,439.11
| Facility | | $8,901.90 | $8,901.90 | $11,439.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.33 / $4,543.49 / $8,058.24
| Facility | | $557.33 | $4,543.49 | $8,058.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |