- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.63 / $10,985.00 / $38,429.26
| Facility | | $1,007.63 | $10,985.00 | $38,429.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $26,869.00 / $45,778.00
| Facility | | $2,575.00 | $26,869.00 | $45,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.21 / $1,064.97 / $1,228.82
| Facility | | $819.21 | $1,064.97 | $1,228.82 |
- 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 |