- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,783.54 / $5,560.00 / $12,154.00
| Facility | | $1,783.54 | $5,560.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,587.00 / $10,500.00
| Facility | | $2,088.00 | $4,587.00 | $10,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,814.00 / $10,814.00 / $10,814.00
| Facility | | $10,814.00 | $10,814.00 | $10,814.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.28 / $2,675.31 / $8,026.00
| Facility | | $1,490.28 | $2,675.31 | $8,026.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,578.00 / $5,252.00 / $19,082.00
| Facility | | $2,578.00 | $5,252.00 | $19,082.00 |