- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.10 / $2,499.73 / $6,882.23
| Facility | | $1,939.10 | $2,499.73 | $6,882.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,528.00 / $14,996.00
| Facility | | $1,760.00 | $3,528.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,292.05 / $2,865.06 / $3,404.29
| Facility | | $2,292.05 | $2,865.06 | $3,404.29 |
- 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
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |