- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.33 / $5,201.00 / $11,679.00
| Facility | | $1,295.33 | $5,201.00 | $11,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.00 / $5,711.00 / $25,522.00
| Facility | | $2,202.00 | $5,711.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.94 / $1,011.53 / $1,343.43
| Facility | | $842.94 | $1,011.53 | $1,343.43 |
- 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 |