- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.58 / $3,401.00 / $10,635.00
| Facility | | $1,227.58 | $3,401.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $6,746.00 / $30,285.00
| Facility | | $2,670.00 | $6,746.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.67 / $1,040.98 / $1,302.05
| Facility | | $819.67 | $1,040.98 | $1,302.05 |
- 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
- $1,043.05 / $1,043.05 / $1,043.05
| Facility | | $1,043.05 | $1,043.05 | $1,043.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,440.00 / $13,382.00
| Facility | | $4,070.00 | $8,440.00 | $13,382.00 |