- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,005.71 / $6,903.82 / $16,467.00
| Facility | | $3,005.71 | $6,903.82 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,017.26 / $6,017.26 / $6,017.26
| Facility | | $6,017.26 | $6,017.26 | $6,017.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.58 / $2,425.85 / $5,109.71
| Facility | | $1,705.58 | $2,425.85 | $5,109.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |