- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,297.23 / $6,980.58 / $11,627.00
| Facility | | $2,297.23 | $6,980.58 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $8,010.00 / $36,529.00
| Facility | | $2,097.00 | $8,010.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.80 / $2,003.80 / $2,917.79
| Facility | | $2,003.80 | $2,003.80 | $2,917.79 |
- 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
- $1,771.00 / $3,098.00 / $6,792.00
| Facility | | $1,771.00 | $3,098.00 | $6,792.00 |