- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,444.16 / $6,064.00 / $11,581.00
| Facility | | $1,444.16 | $6,064.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.00 / $4,918.00 / $19,117.00
| Facility | | $2,003.00 | $4,918.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.48 / $1,132.18 / $1,401.32
| Facility | | $943.48 | $1,132.18 | $1,401.32 |
- 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
- $2,840.00 / $5,998.00 / $7,847.00
| Facility | | $2,840.00 | $5,998.00 | $7,847.00 |