- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.96 / $8,136.28 / $11,581.00
| Facility | | $2,403.96 | $8,136.28 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,920.00 / $17,502.61 / $31,141.30
| Facility | | $5,920.00 | $17,502.61 | $31,141.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,198.46 / $2,398.33 / $3,492.29
| Facility | | $2,198.46 | $2,398.33 | $3,492.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,794.10 / $2,794.10 / $2,794.10
| Facility | | $2,794.10 | $2,794.10 | $2,794.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,440.00 / $13,382.00
| Facility | | $4,070.00 | $8,440.00 | $13,382.00 |