- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,707.84 / $8,384.00 / $12,615.00
| Facility | | $1,707.84 | $8,384.00 | $12,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,813.00 / $17,502.61 / $31,496.21
| Facility | | $6,813.00 | $17,502.61 | $31,496.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,791.58 / $2,166.64 / $2,681.68
| Facility | | $1,791.58 | $2,166.64 | $2,681.68 |
- 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 |