- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.08 / $5,201.00 / $11,627.00
| Facility | | $1,863.08 | $5,201.00 | $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
- $1,092.01 / $1,590.12 / $2,007.38
| Facility | | $1,092.01 | $1,590.12 | $2,007.38 |
- 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
- $3,995.81 / $7,298.00 / $12,871.00
| Facility | | $3,995.81 | $7,298.00 | $12,871.00 |