- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.41 / $2,318.00 / $7,212.00
| Facility | | $1,007.41 | $2,318.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $6,340.00 / $15,727.00
| Facility | | $2,310.00 | $6,340.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.85 / $1,264.71 / $1,459.28
| Facility | | $972.85 | $1,264.71 | $1,459.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,140.62 / $4,140.62 / $4,908.29
| Facility | | $4,140.62 | $4,140.62 | $4,908.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |