- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.38 / $8,035.30 / $11,627.00
| Facility | | $2,187.38 | $8,035.30 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,794.51 / $17,502.61 / $31,141.30
| Facility | | $6,794.51 | $17,502.61 | $31,141.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,173.59 / $2,371.19 / $3,452.78
| Facility | | $2,173.59 | $2,371.19 | $3,452.78 |
- 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
- $2,763.04 / $2,763.04 / $2,763.04
| Facility | | $2,763.04 | $2,763.04 | $2,763.04 |
- 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 |