- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.06 / $7,501.00 / $16,395.00
| Facility | | $1,474.06 | $7,501.00 | $16,395.00 |
- 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
- $987.11 / $1,184.53 / $1,466.11
| Facility | | $987.11 | $1,184.53 | $1,466.11 |
- 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 / $9,067.00 / $15,000.00
| Facility | | $4,534.00 | $9,067.00 | $15,000.00 |