- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.04 / $6,705.22 / $16,042.00
| Facility | | $1,014.04 | $6,705.22 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $10,288.00 / $26,304.00
| Facility | | $2,310.00 | $10,288.00 | $26,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.57 / $1,086.60 / $1,253.78
| Facility | | $852.57 | $1,086.60 | $1,253.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,982.66 / $2,982.66 / $2,982.66
| Facility | | $2,982.66 | $2,982.66 | $2,982.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,025.00 / $11,038.00
| Facility | | $3,932.00 | $8,025.00 | $11,038.00 |