- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.33 / $5,135.00 / $11,679.00
| Facility | | $1,110.33 | $5,135.00 | $11,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.00 / $3,974.00 / $19,117.00
| Facility | | $2,009.00 | $3,974.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.19 / $1,403.98 / $1,506.54
| Facility | | $964.19 | $1,403.98 | $1,506.54 |
- 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
- $4,070.00 / $8,448.00 / $13,382.00
| Facility | | $4,070.00 | $8,448.00 | $13,382.00 |