- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.84 / $3,308.00 / $8,942.39
| Facility | | $1,006.84 | $3,308.00 | $8,942.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,040.74 / $13,992.02 / $21,712.27
| Facility | | $4,040.74 | $13,992.02 | $21,712.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,100.00 / $6,100.00 / $6,100.00
| Facility | | $6,100.00 | $6,100.00 | $6,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.32 / $1,481.55 / $3,277.75
| Facility | | $1,082.32 | $1,481.55 | $3,277.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.00 / $8,842.00 / $16,897.00
| Facility | | $899.00 | $8,842.00 | $16,897.00 |