- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.31 / $5,192.00 / $9,870.00
| Facility | | $1,204.31 | $5,192.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,077.74 / $8,155.06 / $14,268.09
| Facility | | $3,077.74 | $8,155.06 | $14,268.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,081.57 / $6,081.57 / $7,814.93
| Facility | | $6,081.57 | $6,081.57 | $7,814.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.72 / $1,285.28 / $2,069.62
| Facility | | $948.72 | $1,285.28 | $2,069.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |