- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,045.81 / $7,501.00 / $17,014.00
| Facility | | $2,045.81 | $7,501.00 | $17,014.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,565.00 / $5,480.00 / $25,522.00
| Facility | | $2,565.00 | $5,480.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.03 / $1,563.64 / $2,443.19
| Facility | | $1,303.03 | $1,563.64 | $2,443.19 |
- 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
- $4,070.00 / $8,448.00 / $13,382.00
| Facility | | $4,070.00 | $8,448.00 | $13,382.00 |