- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.01 / $4,846.00 / $16,042.00
| Facility | | $1,112.01 | $4,846.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,705.10 / $14,812.00 / $33,821.32
| Facility | | $2,705.10 | $14,812.00 | $33,821.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.78 / $1,410.21 / $1,627.17
| Facility | | $1,084.78 | $1,410.21 | $1,627.17 |
- 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
- $5,431.00 / $12,330.00 / $17,416.00
| Facility | | $5,431.00 | $12,330.00 | $17,416.00 |