- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,198.66 / $6,648.72 / $11,627.00
| Facility | | $2,198.66 | $6,648.72 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.00 / $5,945.00 / $29,406.00
| Facility | | $1,895.00 | $5,945.00 | $29,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,918.28 / $1,918.28 / $2,793.29
| Facility | | $1,918.28 | $1,918.28 | $2,793.29 |
- 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
- $1,480.00 / $3,086.00 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |