- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.71 / $8,288.00 / $11,627.00
| Facility | | $1,315.71 | $8,288.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $8,173.00 / $36,529.00
| Facility | | $2,097.00 | $8,173.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.75 / $1,030.50 / $1,275.47
| Facility | | $858.75 | $1,030.50 | $1,275.47 |
- 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
- $4,534.00 / $8,160.52 / $12,871.00
| Facility | | $4,534.00 | $8,160.52 | $12,871.00 |