- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.88 / $3,683.00 / $8,400.00
| Facility | | $1,144.88 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,666.79 / $13,768.47 / $21,754.02
| Facility | | $8,666.79 | $13,768.47 | $21,754.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,313.01 / $6,313.01 / $6,313.01
| Facility | | $6,313.01 | $6,313.01 | $6,313.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.19 / $1,860.01 / $8,753.15
| Facility | | $1,157.19 | $1,860.01 | $8,753.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,910.00 / $9,232.95
| Facility | | $1,481.00 | $5,910.00 | $9,232.95 |