- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,371.57 / $8,956.00 / $12,627.00
| Facility | | $3,371.57 | $8,956.00 | $12,627.00 |
- 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
- $3,565.97 / $4,296.89 / $5,318.33
| Facility | | $3,565.97 | $4,296.89 | $5,318.33 |
- 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 |