- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.23 / $10,868.00 / $28,756.35
| Facility | | $1,659.23 | $10,868.00 | $28,756.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,740.35 / $9,528.23 / $16,900.34
| Facility | | $3,740.35 | $9,528.23 | $16,900.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $3,711.96 / $4,769.93
| Facility | | $1,130.00 | $3,711.96 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.79 / $1,806.07 / $3,216.53
| Facility | | $1,427.79 | $1,806.07 | $3,216.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |