- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.68 / $4,450.00 / $8,031.00
| Facility | | $1,426.68 | $4,450.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,192.00 / $17,774.00 / $37,069.00
| Facility | | $10,192.00 | $17,774.00 | $37,069.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $843.00 / $843.00
| Facility | | $843.00 | $843.00 | $843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,810.62 / $9,426.00 / $9,617.00
| Facility | | $7,810.62 | $9,426.00 | $9,617.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $3,075.00 / $6,664.00
| Facility | | $1,380.00 | $3,075.00 | $6,664.00 |