- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.07 / $13,423.20 / $29,246.00
| Facility | | $1,787.07 | $13,423.20 | $29,246.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,218.88 / $10,907.69 / $18,562.29
| Facility | | $5,218.88 | $10,907.69 | $18,562.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,229.55 / $6,229.55 / $8,005.08
| Facility | | $6,229.55 | $6,229.55 | $8,005.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.15 / $1,755.34 / $2,868.04
| Facility | | $1,228.15 | $1,755.34 | $2,868.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |