- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.06 / $6,064.00 / $11,627.00
| Facility | | $1,298.06 | $6,064.00 | $11,627.00 |
- 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
- $847.22 / $1,016.66 / $1,258.33
| Facility | | $847.22 | $1,016.66 | $1,258.33 |
- 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 |