- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.60 / $9,923.00 / $22,776.00
| Facility | | $1,020.60 | $9,923.00 | $22,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.00 / $10,862.64 / $18,562.29
| Facility | | $2,187.00 | $10,862.64 | $18,562.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,987.10 / $4,987.10 / $6,408.53
| Facility | | $4,987.10 | $4,987.10 | $6,408.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.26 / $1,106.01 / $1,831.70
| Facility | | $820.26 | $1,106.01 | $1,831.70 |
- 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 |