- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.00 / $4,028.00 / $15,676.00
| Facility | | $1,517.00 | $4,028.00 | $15,676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,611.00 / $5,774.00
| Facility | | $2,132.00 | $3,611.00 | $5,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,483.00 / $26,483.00 / $26,483.00
| Facility | | $26,483.00 | $26,483.00 | $26,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,502.63 / $10,168.04 / $43,926.00
| Facility | | $5,502.63 | $10,168.04 | $43,926.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,567.00 / $7,604.00
| Facility | | $2,426.00 | $4,567.00 | $7,604.00 |