- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,105.25 / $8,031.00 / $11,356.00
| Facility | | $2,105.25 | $8,031.00 | $11,356.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,931.00 / $17,774.00 / $41,690.28
| Facility | | $8,931.00 | $17,774.00 | $41,690.28 |
- 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
- $2,346.67 / $2,469.56 / $20,667.00
| Facility | | $2,346.67 | $2,469.56 | $20,667.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,943.00 / $10,336.00 / $17,069.00
| Facility | | $6,943.00 | $10,336.00 | $17,069.00 |