- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,549.40 / $11,550.00 / $22,776.00
| Facility | | $1,549.40 | $11,550.00 | $22,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,292.84 / $10,843.93 / $18,562.29
| Facility | | $4,292.84 | $10,843.93 | $18,562.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,229.55 / $6,229.55 / $8,005.08
| Facility | | $6,229.55 | $6,229.55 | $8,005.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.92 / $1,717.25 / $2,813.89
| Facility | | $1,242.92 | $1,717.25 | $2,813.89 |
- 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 |