- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,955.88 / $4,908.03 / $10,492.00
| Facility | | $2,955.88 | $4,908.03 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,098.00 / $17,774.00 / $26,880.01
| Facility | | $12,098.00 | $17,774.00 | $26,880.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $843.00 / $843.00
| Facility | | $843.00 | $843.00 | $843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.67 / $11,057.00 / $11,283.00
| Facility | | $2,346.67 | $11,057.00 | $11,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,943.00 / $10,336.00 / $17,069.00
| Facility | | $6,943.00 | $10,336.00 | $17,069.00 |