- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,677.15 / $8,144.53 / $11,627.00
| Facility | | $2,677.15 | $8,144.53 | $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
- $2,333.92 / $2,333.92 / $3,398.53
| Facility | | $2,333.92 | $2,333.92 | $3,398.53 |
- 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 |