- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.43 / $5,201.00 / $11,581.00
| Facility | | $1,146.43 | $5,201.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,576.00 / $14,996.00
| Facility | | $1,760.00 | $3,576.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.59 / $770.82 / $1,122.41
| Facility | | $706.59 | $770.82 | $1,122.41 |
- 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
- $796.77 / $910.25 / $2,334.67
| Facility | | $796.77 | $910.25 | $2,334.67 |
- 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 |