- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,716.59 / $8,037.00 / $11,754.00
| Facility | | $1,716.59 | $8,037.00 | $11,754.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $7,982.00 / $36,529.00
| Facility | | $2,097.00 | $7,982.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,099.58 / $1,319.50 / $2,061.71
| Facility | | $1,099.58 | $1,319.50 | $2,061.71 |
- 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
- $4,873.00 / $10,707.00 / $15,469.00
| Facility | | $4,873.00 | $10,707.00 | $15,469.00 |