- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.77 / $9,062.00 / $18,276.00
| Facility | | $1,340.77 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.85 / $9,696.57 / $16,579.43
| Facility | | $4,613.85 | $9,696.57 | $16,579.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,418.26 / $5,418.26 / $5,418.26
| Facility | | $5,418.26 | $5,418.26 | $5,418.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.03 / $1,443.08 / $1,889.28
| Facility | | $1,036.03 | $1,443.08 | $1,889.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,666.00 / $16,223.00 / $23,485.00
| Facility | | $2,666.00 | $16,223.00 | $23,485.00 |