- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,996.40 / $8,031.00 / $11,356.00
| Facility | | $2,996.40 | $8,031.00 | $11,356.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,192.00 / $24,163.00 / $65,614.64
| Facility | | $10,192.00 | $24,163.00 | $65,614.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $843.00 / $843.00
| Facility | | $843.00 | $843.00 | $843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.67 / $2,466.00 / $2,518.00
| Facility | | $2,346.67 | $2,466.00 | $2,518.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,838.00 / $14,587.00 / $21,600.00
| Facility | | $8,838.00 | $14,587.00 | $21,600.00 |