- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.06 / $6,075.00 / $11,627.00
| Facility | | $1,253.06 | $6,075.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,426.00 / $19,117.00
| Facility | | $2,084.00 | $4,426.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.26 / $1,202.71 / $1,488.61
| Facility | | $1,002.26 | $1,202.71 | $1,488.61 |
- 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
- $3,793.00 / $6,579.00 / $11,097.00
| Facility | | $3,793.00 | $6,579.00 | $11,097.00 |