- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.52 / $4,723.00 / $11,627.00
| Facility | | $1,130.52 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,426.00 / $19,117.00
| Facility | | $2,084.00 | $4,426.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.85 / $1,425.34 / $1,799.37
| Facility | | $978.85 | $1,425.34 | $1,799.37 |
- 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 |