- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.63 / $4,590.00 / $14,100.00
| Facility | | $1,019.63 | $4,590.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,723.84 / $13,547.08 / $21,288.26
| Facility | | $8,723.84 | $13,547.08 | $21,288.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.93 / $1,516.21 / $13,541.98
| Facility | | $755.93 | $1,516.21 | $13,541.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,871.00 / $13,541.98
| Facility | | $1,851.00 | $6,871.00 | $13,541.98 |