- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.25 / $2,472.00 / $17,225.00
| Facility | | $1,042.25 | $2,472.00 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,719.00 / $10,076.00 / $23,814.00
| Facility | | $3,719.00 | $10,076.00 | $23,814.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.68 / $1,051.06 / $1,212.77
| Facility | | $824.68 | $1,051.06 | $1,212.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,033.31 / $4,033.31 / $4,033.31
| Facility | | $4,033.31 | $4,033.31 | $4,033.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,296.00 / $17,380.00
| Facility | | $5,431.00 | $12,296.00 | $17,380.00 |