- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.71 / $7,155.00 / $14,579.00
| Facility | | $1,653.71 | $7,155.00 | $14,579.00 |
- 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
- $976.63 / $1,422.10 / $1,795.28
| Facility | | $976.63 | $1,422.10 | $1,795.28 |
- 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 / $8,796.00 / $13,009.00
| Facility | | $4,070.00 | $8,796.00 | $13,009.00 |