- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.51 / $17,225.00 / $31,907.88
| Facility | | $1,088.51 | $17,225.00 | $31,907.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $24,214.00 / $45,778.00
| Facility | | $2,575.00 | $24,214.00 | $45,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.67 / $1,150.46 / $1,327.46
| Facility | | $902.67 | $1,150.46 | $1,327.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,561.47 / $6,561.47 / $6,561.47
| Facility | | $6,561.47 | $6,561.47 | $6,561.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,296.00 / $17,380.00
| Facility | | $5,431.00 | $12,296.00 | $17,380.00 |