- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.76 / $5,355.00 / $10,817.74
| Facility | | $1,206.76 | $5,355.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,437.00 / $19,117.00
| Facility | | $2,084.00 | $4,437.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.93 / $898.72 / $1,112.35
| Facility | | $748.93 | $898.72 | $1,112.35 |
- 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
- $3,757.73 / $5,726.00 / $9,483.00
| Facility | | $3,757.73 | $5,726.00 | $9,483.00 |