- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,182.31 / $6,682.71 / $11,627.00
| Facility | | $2,182.31 | $6,682.71 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,638.88 / $7,944.89 / $15,216.00
| Facility | | $3,638.88 | $7,944.89 | $15,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,893.92 / $2,757.83 / $2,959.26
| Facility | | $1,893.92 | $2,757.83 | $2,959.26 |
- 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 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |