- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.19 / $3,193.97 / $10,268.00
| Facility | | $1,030.19 | $3,193.97 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $5,544.00 / $30,285.00
| Facility | | $2,670.00 | $5,544.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.86 / $813.52 / $1,080.45
| Facility | | $633.86 | $813.52 | $1,080.45 |
- 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
- $813.53 / $813.53 / $813.53
| Facility | | $813.53 | $813.53 | $813.53 |
- 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 |