- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.96 / $6,758.67 / $11,627.00
| Facility | | $2,015.96 | $6,758.67 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.00 / $14,489.11 / $24,772.14
| Facility | | $4,142.00 | $14,489.11 | $24,772.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.03 / $2,304.04 / $2,851.74
| Facility | | $1,920.03 | $2,304.04 | $2,851.74 |
- 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
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |