- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,111.22 / $2,855.84 / $10,985.00
| Facility | | $1,111.22 | $2,855.84 | $10,985.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,705.10 / $16,700.00 / $33,821.32
| Facility | | $2,705.10 | $16,700.00 | $33,821.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.06 / $1,410.58 / $1,627.59
| Facility | | $1,085.06 | $1,410.58 | $1,627.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.12 / $4,705.12 / $5,577.46
| Facility | | $4,705.12 | $4,705.12 | $5,577.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.00 / $12,330.00 / $17,416.00
| Facility | | $5,058.00 | $12,330.00 | $17,416.00 |