- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,212.29 / $6,709.11 / $11,627.00
| Facility | | $2,212.29 | $6,709.11 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.99 / $1,831.00 / $3,840.45
| Facility | | $870.99 | $1,831.00 | $3,840.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,931.36 / $1,931.36 / $2,812.33
| Facility | | $1,931.36 | $1,931.36 | $2,812.33 |
- 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 |