- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.57 / $5,201.00 / $11,627.00
| Facility | | $1,073.57 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,674.00 / $6,565.00 / $30,285.00
| Facility | | $2,674.00 | $6,565.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.46 / $846.37 / $1,124.08
| Facility | | $659.46 | $846.37 | $1,124.08 |
- 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
- $844.41 / $844.41 / $844.41
| Facility | | $844.41 | $844.41 | $844.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,625.00 / $7,847.00
| Facility | | $2,840.00 | $5,625.00 | $7,847.00 |