- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $15,488.17
| Facility | | $2,818.38 | $7,079.46 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $19,498.45 / $26,915.35
| Facility | | $8,912.51 | $19,498.45 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $15,135.61 / $15,488.17
| Facility | | $15,135.61 | $15,135.61 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,754.40 / $10,000.00
| Facility | | $1,513.56 | $5,754.40 | $10,000.00 |