- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.60 / $5,939.00 / $12,237.00
| Facility | | $1,190.60 | $5,939.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,781.25 / $3,455.61 / $4,808.05
| Facility | | $1,781.25 | $3,455.61 | $4,808.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,432.00 / $11,432.00 / $11,432.00
| Facility | | $11,432.00 | $11,432.00 | $11,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.70 / $1,196.03 / $8,038.00
| Facility | | $708.70 | $1,196.03 | $8,038.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,170.00 / $12,989.00
| Facility | | $2,269.00 | $6,170.00 | $12,989.00 |