- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.11 / $5,560.00 / $12,292.00
| Facility | | $1,828.11 | $5,560.00 | $12,292.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,806.00 / $10,806.00 / $22,871.00
| Facility | | $10,806.00 | $10,806.00 | $22,871.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,219.54 / $2,415.86 / $26,542.00
| Facility | | $1,219.54 | $2,415.86 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,390.00 / $12,989.00
| Facility | | $2,426.00 | $4,390.00 | $12,989.00 |