- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,192.19 / $5,616.00 / $10,817.74
| Facility | | $1,192.19 | $5,616.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,437.00 / $19,117.00
| Facility | | $2,084.00 | $4,437.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.23 / $696.23 / $1,013.81
| Facility | | $696.23 | $696.23 | $1,013.81 |
- 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 |