- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,814.45 / $8,037.00 / $12,615.00
| Facility | | $1,814.45 | $8,037.00 | $12,615.00 |
- 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
- $1,240.56 / $1,488.67 / $1,842.55
| Facility | | $1,240.56 | $1,488.67 | $1,842.55 |
- 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
- $3,206.00 / $6,578.00 / $10,075.00
| Facility | | $3,206.00 | $6,578.00 | $10,075.00 |