- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.55 / $8,037.00 / $11,754.00
| Facility | | $1,006.55 | $8,037.00 | $11,754.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $4,470.00 / $19,117.00
| Facility | | $2,258.00 | $4,470.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.63 / $590.63 / $860.04
| Facility | | $590.63 | $590.63 | $860.04 |
- 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
- $4,227.00 / $9,125.00 / $14,134.00
| Facility | | $4,227.00 | $9,125.00 | $14,134.00 |