- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,792.07 / $9,496.00 / $14,156.00
| Facility | | $3,792.07 | $9,496.00 | $14,156.00 |
- 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
- $3,920.33 / $4,785.80 / $5,923.47
| Facility | | $3,920.33 | $4,785.80 | $5,923.47 |
- 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 |