- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,169.44 / $7,253.55 / $11,627.00
| Facility | | $2,169.44 | $7,253.55 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.00 / $12,455.21 / $21,287.94
| Facility | | $4,142.00 | $12,455.21 | $21,287.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,058.05 / $2,469.66 / $3,056.74
| Facility | | $2,058.05 | $2,469.66 | $3,056.74 |
- 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 |