- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $9,248.33 / $19,276.96
| Facility | | $4,382.00 | $9,248.33 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,751.95 / $13,216.42 / $24,810.59
| Facility | | $9,751.95 | $13,216.42 | $24,810.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.85 / $1,396.73 / $8,816.00
| Facility | | $787.85 | $1,396.73 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $1,883.89 / $4,791.04
| Facility | | $1,375.00 | $1,883.89 | $4,791.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |