- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,956.03 / $8,037.00 / $11,754.00
| Facility | | $1,956.03 | $8,037.00 | $11,754.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,932.00 / $12,098.50 / $22,852.30
| Facility | | $4,932.00 | $12,098.50 | $22,852.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.95 / $1,538.34 / $1,904.03
| Facility | | $1,281.95 | $1,538.34 | $1,904.03 |
- 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
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |